Stereoscopic camera with fluorescence visualization

ABSTRACT

A stereoscopic camera with fluorescence visualization is disclosed. An example stereoscopic camera includes a visible light source, a near-ultraviolet light source, and a near-ultraviolet light source. The stereoscopic camera also includes a light filter assembly having left and right filter magazines positioned respectively along left and right optical paths and configured to selectively enable certain wavelengths of light to pass through. Each of the left and right filter magazines includes an infrared cut filter, a near-ultraviolent cut filter, and a near-infrared bandpass filter. A controller of the camera is configured to provide for a visible light mode, an indocyanine green (“ICG”) fluorescence mode, and a 5-aminolevulinic acid (“ALA”) fluorescence mode by synchronizing the activation of the light sources with the selection of the filters. A processor of the camera combines image data from the different modes to enable fluorescence emission light to be superimposed on visible light stereoscopic images.

PRIORITY CLAIM

The present application is a continuation-in-part of U.S. patentapplication Ser. No. 16/422,204 filed on May 24, 2019, which is acontinuation application of U.S. patent application Ser. No. 15/814,127filed on Nov. 15, 2017, now U.S. Pat. No. 10,299,880, which is anon-provisional of and claims priority to and the benefit of U.S.Provisional Patent Application No. 62/489,289 filed on Apr. 24, 2017 andU.S. Provisional Patent Application No. 62/489,876 filed on Apr. 25,2017, the entirety of which are incorporated herein by reference.

BACKGROUND

Surgery is art. Accomplished artists create works of art that far exceedthe capabilities of a normal person. Artists use a brush to turncanisters of paint into vivid images that provoke strong and uniqueemotions from viewers. Artists take ordinary words written on paper andturn them into dramatic and awe-inspiring performances. Artists graspinstruments causing them to emit beautiful music. Similarly, surgeonstake seemingly ordinary scalpels, tweezers, and probes and producelife-altering biological miracles.

Like artists, surgeons have their own methods and preferences. Aspiringartists are taught the fundamentals of their craft. Beginners oftenfollow prescribed methods. As they gain experience, confidence, andknowledge, they develop their own unique artistry reflective ofthemselves and their personal environment. Similarly, medical studentsare taught the fundamentals of surgical procedures. They are rigorouslytested on these methods. As the students progress through residency andprofessional practice, they develop derivations of the fundamentals(still within medical standards) based on how they believe the surgeryshould best be completed. For instance, consider the same medicalprocedure performed by different renowned surgeons. The order of events,pacing, placement of staff, placement of tools, and use of imagingequipment varies between each of the surgeons based on theirpreferences. Even incision sizes and shapes can be unique to thesurgeon.

The artistic-like uniqueness and accomplishment of surgeons make themweary of surgical tools that change or alter their methods. The toolshould be an extension of the surgeon, operating simultaneously and/orin harmonious synchronization. Surgical tools that dictate the flow of aprocedure or change the rhythm of a surgeon are often discarded ormodified to conform.

In an example, consider microsurgery visualization where certainsurgical procedures involve patient structures that are too small for ahuman to visualize easily with the naked eye. For these microsurgeryprocedures, magnification is required to adequately view themicro-structures. Surgeons generally want visualization tools that arenatural extensions of their eyes. Indeed, early efforts at microsurgeryvisualization comprised attaching magnifying lens to head-mountedoptical eyepieces (called surgical loupes). The first pair was developedin 1876. Vastly improved versions of surgical loupes (some includingoptical zooms and integrated light sources) are still being used bysurgeons today. FIG. 1 shows a diagram of a pair of surgical loupes 100with a light source 102 and magnification lenses 104. The 150-yearstaying power of surgical loupes can be attributed to the fact that theyare literally an extension of a surgeon's eyes.

Despite their longevity, surgical loupes are not perfect. Loupes withmagnifying lenses and light sources, such as the loupes 100 of FIG. 1,have much greater weight. Placing even a minor amount of weight on thefront of a surgeon's face can increase discomfort and fatigue,especially during prolonged surgeries. The surgical loupes 100 alsoinclude a cable 106 that is connected to a remote power supply. Thecable effectively acts as a chain, thereby limiting the mobility of thesurgeon during their surgical performance.

Another microsurgery visualization tool is the surgical microscope, alsoreferred to as the operating microscope. Widespread commercialdevelopment of surgical microscopes began in the 1950s with theintention of replacing surgical loupes. Surgical microscopes includeoptical paths, lenses, and focusing elements that provide greatermagnification compared to surgical loupes. The large array of opticalelements (and resulting weight) meant that surgical microscopes had tobe detached from the surgeon. While this detachment gave the surgeonmore room to maneuver, the bulkiness of the surgical microscope causedit to consume considerable operating space above a patient, therebyreducing the size of the surgical stage.

FIG. 2 shows a diagram of a prior art surgical microscope 200. As onecan imagine, the size and presence of the surgical microscope in theoperating area made it prone to bumping. To provide stability andrigidity at the scope head 201, the microscope is connected torelatively large boom arms 202 and 204 or other similar supportstructure. The large boom arms 202 and 204 consume additional surgicalspace and reduce the maneuverability of the surgeon and staff. In total,the surgical microscope 200 shown in FIG. 2 could weigh as much as 350kilograms (“kg”).

To view a target surgical site using the surgical microscope 200, asurgeon looks directly though oculars 206. To reduce stress on asurgeon's back, the oculars 206 are generally positioned along asurgeon's natural line of sight using the arm 202 to adjust height.However, surgeons do not perform by only looking at a target surgicalsite. The oculars 206 have to be positioned such that the surgeon iswithin arm's length of a working distance to the patient. Such precisepositioning is critical to ensure the surgical microscope 200 becomes anextension rather than a hindrance to the surgeon, especially when beingused for extended periods of time.

Like any complex instrument, it takes surgeons tens to hundreds of hoursto feel comfortable using a surgical microscope. As shown in FIG. 2, thedesign of the surgical microscope 200 requires a substantially 90° angleoptical path from the surgeon to the target surgical site. For instance,a perfectly vertical optical path is required from the target surgicalsite to the scope head 201. This means that the scope head 201 has to bepositioned directly above the patient for every microsurgical procedure.In addition, the surgeon has to look almost horizontally (or some slightangle downward) into the oculars 206. A surgeon's natural inclination isto direct his vision to his hands at the surgical site. Some surgeonseven want to move their heads closer to the surgical site to have moreprecise control of their hand movements. Unfortunately, the surgicalmicroscopes 200 do not give surgeons this flexibility. Instead, surgicalmicroscopes 200 ruthlessly dictate that the surgeon is to place theireyes on the oculars 206 and hold their head at arm's length during theirsurgical performance, all while consuming valuable surgical space abovethe patient. A surgeon cannot even simply look down at a patient becausethe scope head 201 blocks the surgeon's view.

To make matters worse, some surgical microscopes 200 include a secondpair of oculars 208 for co-performers (e.g., assistant surgeons, nurses,or other clinical staff). The second pair of oculars 208 is usuallypositioned at a right angle from the first oculars 206. The closenessbetween the oculars 206 and 208 dictates that the assistant must stand(or sit) in close proximity to the surgeon, further restrictingmovement. This can be annoying to some surgeons who like to perform withsome space. Despite their magnification benefits surgical microscopes200 are not natural extensions of a surgeon. Instead, they areoverbearing directors in the surgical room.

SUMMARY

The present disclosure is directed to stereoscopic visualization cameraand platform that is configured to effectively operate as an extensionof a surgeon's eyes while giving the surgeon the freedom to conduct amicrosurgery procedure generally without restrictions. The examplestereoscopic visualization camera disclosed herein comprises a digitalstereoscopic visualization platform with full-range,operator-independent orientation for microsurgical applications. Theexample stereoscopic visualization camera and platform decouples themicro-surgery visualization system from a surgeon's head and eyes toprovide for a wide variety of multi-axis orientations of the surgicalvisualization system relative to the surgeon and to the target surgicalfield. As a result, the surgeon is provided with an enhanced magnifiedview of the surgical site without having to work around a bulkymicroscope positioned over the patient and in front of the surgeon'sface. The example stereoscopic visualization camera accordingly enablesa surgeon to complete life-altering microsurgeries comfortably inwhatever position suits the surgeon. Moreover, the surgicalvisualization camera of the present disclosure can be positioned alongand about any number of orientations relative to the surgical field thatbest suit the needs of the surgeon or patient, rather than the physicaland mechanical limitations of the visualization apparatus.

The example stereoscopic visualization camera and corresponding platformhas many distinct advantages over known monoscopic and stereoscopiccameras. Current monoscopic and stereoscopic cameras are connected to anoptical path of a surgical microscope. While being connected to theoptical path, the cameras have no control over focus, zooming, and/orsetting a working distance. Instead, these controls are located at thescope head of the surgical microscope. In addition, optical elements ina surgical microscope provide generally acceptable image quality foroculars. However, defects in the image quality or slightly misalignedright and left views become more apparent when acquired by a camera anddisplayed on a video monitor.

The example stereoscopic visualization camera overcomes theabove-mentioned issues of known monoscopic and stereoscopic cameras bybeing configured as a self-contained device that does not rely onexternal microscope optical elements. The example stereoscopicvisualization camera instead internalizes the optical elements that arecommon on a surgical microscope. The optical elements may be provided ontracks and/or flexures within the camera to allow for manual and/orautomatic adjustment. Accordingly, adjustment of the optical elementscan be provided through camera controls and/or user input devicesconnected to the camera, which enables adjustment to be madespecifically for the camera. In addition, the optical elements of thestereoscopic visualization camera may be automatically and/or manuallyadjusted to align focus points of left and right images and reducevisual defects and/or spurious parallax. The end result is a relativelylightweight maneuverable stereoscopic visualization camera that providesa virtually flawless three-dimensional stereoscopic display that allowssurgeons to practice their art without visual encumbrances.

In an example embodiment, a stereoscopic imaging apparatus is configuredto reduce spurious parallax between first and second images streamsacquired or recorded in parallel of a target site. The apparatusincludes first optical elements positioned along a first optical path.The first optical elements comprise a first plurality of lensesincluding a first zoom lens configured to be moveable along the firstoptical path in a z-direction and a first image sensor to acquire thefirst image stream of the target site from light in the first opticalpath. The apparatus also includes second optical elements positionedalong a second optical path parallel to the first optical path. Thesecond optical elements comprise a second plurality of lenses includinga second zoom lens configured to be moveable along the second opticalpath in a z-direction and a second image sensor to acquire the secondimage stream of the target site from light in the second optical path.The apparatus further includes a processor configured to locate aposition of a first zoom repeat point (“ZRP”) by causing the first zoomlens to move along the z-direction during a recording of the first imagestream, locating a first portion of area that does not move in anx-direction or a y-direction within the images of the first imagestream, and determining a first distance between an origin point withinat least one of the images of the first image stream and the firstportion of the area as the position of the first ZRP. The exampleprocessor is also configured to determine a first pixel set of a firstpixel grid of the first image sensor using the first distance such thatthe first ZRP is located at a center of the first pixel set anddetermine a second pixel set of a second pixel grid of the second imagesensor that includes an image that is aligned with an image from thefirst pixel set of the first image sensor. The example processor isfurther configured to locate a position of a second ZRP by causing thesecond lens to move along the z-direction during a recording of thesecond image stream, locating a second portion of area that does notmove in the x-direction or the y-direction within the images of thesecond image stream, and determining a second distance between a centerof the second pixel set and the second portion of the area as theposition of the second ZRP. Moreover, the example processor isconfigured to adjust one of the second plurality of lenses or the secondimage sensor in at least one of the x-direction, the y-direction, and atilt-direction to cause the second ZRP to be aligned with the center ofthe second pixel set based on the determined second distance.

The example processor reduces or eliminates spurious parallax bydetermining a first pixel set of a first pixel grid of the first imagesensor using the first distance such that the first ZRP is located at acenter of the first pixel set. In addition, the processor determines asecond pixel set of a second pixel grid of the second image sensor thatincludes an image that is aligned with an image from the first pixel setof the first image sensor. Further, the example processor adjusts one ofthe second plurality of lenses in at least one of the x-direction andthe y-direction and a tilt direction to cause the second ZRP to bealigned with a center of the second pixel set based on the determinedsecond distance. In an alternative embodiment, the example processor maydigitally change an optical property of the one of the second pluralityof lenses to have the same effect as moving the one of the secondplurality of lenses. The processor stores the location of the first andsecond pixel sets in relation to a magnification level of the first andsecond zoom lenses as a calibration point. The processor may use thecalibration point and select the stored locations of the pixel sets whenthe stereoscopic imaging apparatus subsequently returns to the same or asimilar magnification level.

In another embodiment, a stereoscopic imaging apparatus is configured toprovide for fluorescence visualization. In this embodiment, thestereoscopic imaging apparatus includes a main objective assemblyconfigured to change a working distance along an optical axis to atarget surgical site, and left and right lens sets defining respectiveparallel left and right optical paths along the optical axis andconfigured to form the respective optical paths from light that isreceived from the main objective assembly of the target surgical site.The stereoscopic imaging apparatus also includes a light filter assemblyhaving left and right filter magazines positioned respectively along theleft and right optical paths and configured to selectively enablecertain wavelengths of the light to pass through. Each of the left andright filter magazines includes an infrared cut filter, anear-ultraviolent cut filter, and a near-infrared bandpass filter. Thestereoscopic imaging apparatus further includes left and right imagesensors configured to receive the filtered light and convert thefiltered light into image data that is indicative of the receivedfiltered light, and a processor communicatively coupled to the left andright image sensors and configured to convert the image data intostereoscopic video signals or video data for display on a displaymonitor. Additionally, the stereoscopic imaging apparatus includes adeflecting element located between the main objective assembly and theleft and right lens sets. The deflecting element is configured toreflect the light received from the main objective assembly to the leftand right lens sets. Moreover, the stereoscopic imaging apparatusincludes a visible light source positioned to transmit visible lightthrough the main objective assembly to the target surgical site, anear-infrared light source positioned to transmit near-infrared lightthrough the main objective assembly to the target surgical site, and anexcitation filter positioned in front of the near-infrared light sourceconfigured to enable light at indocyanine green (“ICG”) fluorescenceabsorption wavelengths to pass through. Further, the stereoscopicimaging apparatus includes a controller configured to provide a visiblelight mode by causing the visible light reflected from the targetsurgical site to be provided to the left and right image sensors byactivating the visible light source and selecting at least one of theinfrared cut filter or the near-ultraviolet cut filter to be placed inthe respective optical path, provide an ICG fluorescence mode by causingICG fluorescence emission light from the target surgical site to beprovided to the left and right image sensors by activating at least oneof the visible light source or the near-infrared light source andselecting the near-infrared bandpass filter to be placed in therespective optical path, and switch between the visible light mode andthe ICG mode to enable the processor to provide stereoscopic videosignals or video data with at least some image data corresponding to theICG fluorescence emission light to be superimposed on image datacorresponding to the visible light.

The advantages discussed herein may be found in one, or some, andperhaps not all of the embodiments disclosed herein. Additional featuresand advantages are described herein, and will be apparent from thefollowing Detailed Description and the figures.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 shows a diagram of a pair of prior art surgical loupes.

FIG. 2 shows a diagram of a prior art surgical microscope.

FIGS. 3 and 4 show diagrams of perspective views of a stereoscopicvisualization camera, according to an example embodiment of the presentdisclosure.

FIGS. 5 and 6 show diagrams of a microsurgical environment including thestereoscopic visualization camera of FIGS. 3 and 4, according to exampleembodiments of the present disclosure.

FIGS. 7 and 8 show diagrams illustrative of optical elements within theexample stereoscopic visualization camera of FIGS. 3 to 6, according toan example embodiment of the present disclosure.

FIG. 9 shows a diagram of a deflecting element of the examplestereoscopic visualization camera of FIGS. 7 and 8, according to anexample embodiment of the present disclosure.

FIG. 10 shows a diagram of an example of a right optical image sensorand a left optical image sensor of the example stereoscopicvisualization camera of FIGS. 7 and 8, according to an exampleembodiment of the present disclosure.

FIGS. 11 and 12 show diagrams of example carriers for optical elementsof the example stereoscopic visualization camera of FIGS. 7 and 8,according to example embodiments of the present disclosure.

FIG. 13 shows a diagram of an example flexure of the examplestereoscopic visualization camera of FIGS. 7 and 8, according to anexample embodiment of the present disclosure.

FIG. 14 shows a diagram of modules of the example stereoscopicvisualization camera for acquiring and processing image data, accordingto an example embodiment of the present disclosure.

FIG. 15 shows a diagram of internal components of the modules of FIG.14, according to an example embodiment of the present disclosure.

FIG. 16 shows a diagram of an information processor module of FIGS. 14and 15, according to an example embodiment of the present disclosure.

FIG. 17 shows an example of a display monitor, according to an exampleembodiment of the present disclosure.

FIGS. 18 to 21 show diagrams illustrative of spurious parallax betweenright and left optical paths.

FIG. 22 shows a diagram illustrative of an out-of-focus condition inrelation to a position of two parallel lenses for respective right andleft optical paths.

FIGS. 23 and 24 show diagrams illustrative of how spurious parallaxcauses digital graphics and/or images to lose accuracy when fused to astereoscopic image.

FIGS. 25 and 26 illustrate a flow diagram showing an example procedureto reduce or eliminate spurious parallax, according to an exampleembodiment of the present disclosure.

FIG. 27 shows a diagram illustrative of how a zoom repeat point isadjusted with respect to a pixel grid of an optical image sensor,according to an example embodiment of the present disclosure.

FIGS. 28 to 32 show diagrams illustrative of a template matching programto locate a zoom repeat point, according to an example embodiment of thepresent disclosure.

FIGS. 33 and 34 show diagrams of a filter assembly of FIGS. 7 and 8,according to example embodiments of the present disclosure.

FIG. 35 shows a diagram illustrative of how the stereoscopicvisualization camera of FIG. 3 uses a near-infrared (“NIR”) light sourcewith a filter assembly for providing light corresponding to indocyaninegreen (“ICG”) emission wavelengths to image sensors, according to anexample embodiment of the present disclosure.

FIG. 36 shows a diagram of an example procedure for providing a livestereoscopic view of visible light and ICG fluorescence at the sametime, according to an example embodiment of the present disclosure.

FIG. 37 shows a diagram illustrative of how the stereoscopicvisualization camera of FIG. 3 uses a near-ultraviolet (“NUV”) lightsource with a filter assembly for providing light corresponding to5-aminolevulinic acid (“ALA”) emission wavelengths to image sensors,according to an example embodiment of the present disclosure.

FIG. 38 shows a diagram of an example procedure for providing a livestereoscopic view of visible light and 5-ALA fluorescence at the sametime, according to an example embodiment of the present disclosure.

DETAILED DESCRIPTION

The present disclosure relates in general to a stereoscopicvisualization camera and platform. The stereoscopic visualization cameramay be referred to as a digital stereoscopic microscope (“DSM”). Theexample camera and platform are configured to integrate microscopeoptical elements and video sensors into a self-contained head unit thatis significantly smaller, lighter, and more maneuverable than prior artmicroscopes (such as the surgical loupes 100 of FIG. 1 and the surgicalmicroscope 200 of FIG. 2). The example camera is configured to transmita stereoscopic video signal to one or more television monitors,projectors, holographic devices, smartglasses, virtual reality devices,or other visual display devices within a surgical environment.

The monitors or other visual display devices may be positioned withinthe surgical environment to be easily within a surgeon's line of sightwhile performing surgery on a patient. This flexibility enables thesurgeon to place display monitors based on personal preferences orhabits. In addition, the flexibility and slim profile of thestereoscopic visualization camera disclosed herein reduces area consumedover a patient. Altogether, the stereoscopic visualization camera andmonitors (e.g., the stereoscopic visualization platform) enables asurgeon and surgical team to perform complex microsurgical surgicalprocedures on a patient without being dictated or restricted in movementcompared to the surgical microscope 200 discussed above. The examplestereoscopic visualization platform accordingly operates as an extensionof the surgeon's eyes, enabling the surgeon to perform masterpiecemicrosurgeries without dealing with the stress, restrictions, andlimitations induced by previous known visualization systems.

The disclosure herein generally refers to microsurgery. The examplestereoscopic visualization camera may be used in virtually anymicrosurgical procedure including, for example, cranial surgery, brainsurgery, neurosurgery, spinal surgery, ophthalmologic surgery, cornealtransplants, orthopedic surgery, ear, nose and throat surgery, dentalsurgery, plastics and reconstructive surgery, or general surgery.

The disclosure also refers herein to target site, scene, orfield-of-view. As used herein, target site or field-of-view includes anobject (or portion of an object) that is being recorded or otherwiseimaged by the example stereoscopic visualization camera. Generally thetarget site, scene, or field-of-view is a working distance away from amain objective assembly of the example stereoscopic visualization cameraand is aligned with the example stereoscopic visualization camera. Thetarget site may include a patient's biological tissue, bone, muscle,skin or combinations thereof. In these instances, the target site may bethree dimensional by having a depth component corresponding to aprogression of a patient's anatomy. The target site may also include oneor more templates used for calibration or verification of the examplestereoscopic visualization camera. The templates may be two-dimensional,such as a graphic design on paper (or plastic sheet) or threedimensional, such as to approximate a patient's anatomy in a certainregion.

Reference is also made throughout to an x-direction, a y-direction, az-direction, and a tilt-direction. The z-direction is along an axis fromthe example stereoscopic visualization camera to the target site andgenerally refers to depth. The x-direction and y-direction are in aplane incident to the z-direction and comprise a plane of the targetsite. The x-direction is along an axis that is 90° from an axis of they-direction. Movement along the x-direction and/or the y-direction referto in-plane movement and may refer to movement of the examplestereoscopic visualization camera, movement of optical elements withinthe example stereoscopic visualization camera, and/or movement of thetarget site.

The tilt-direction corresponds movement along Euler angles (e.g., a yawaxis, a pitch axis, and a roll axis) with respect to the x-direction,the y-direction, and/or the z-direction. For example, a perfectlyaligned lens has substantially a 0° tilt with respect to thex-direction, the y-direction, and/or the z-direction. In other words, aface of the lens is 90° or perpendicular to light along the z-direction.In addition, edges of the lens (if the lens has a rectangular shape) areparallel along the x-direction and the y-direction. Lens and/or opticalimage sensors can be titled through yaw movement, pitch movement, and/orroll movement. For example, a lens and/or optical image sensor may betitled along a pitch axis, with respect to the z-direction, to faceupwards or downwards. Light along the z-direction contacts a face of alens (that is pitched upwards or downwards) at non-perpendicular angle.Tilting of a lens and/or optical image sensor along a yaw axis, pitchaxis, or roll axis enables, for example, a focal point or ZRP to beadjusted.

I. Example Stereoscopic Visualization Camera

FIGS. 3 and 4 show diagrams of perspective views of a stereoscopicvisualization camera 300, according to an example embodiment of thepresent disclosure. The example camera 300 includes a housing 302configured to enclose optical elements, lens motors (e.g., actuators),and signal processing circuitry. The camera 300 has a width (along anx-axis) between 15 to 28 centimeters (cm), preferably around 22 cm. Inaddition, the camera 300 has a length (along a y-axis) between 15 to 32cm, preferably around 25 cm. Further, the camera 300 has a height (alonga z-axis) between 10 to 20 cm, preferably around 15 cm. The weight ofthe camera 300 is between 3 to 7 kg, preferably around 3.5 kg.

The camera 300 also includes control arms 304 a and 304 b (e.g.,operating handles), which are configured to control magnification level,focus, and other microscope features. The control arms 304 a and 304 bmay include respective controls 305 a and 305 b for activating orselecting certain features. For example, the control arms 304 a and 304b may include controls 305 a and 305 b for selecting a fluorescencemode, adjusting an amount/type of light projected onto a target site,and controlling a display output signal (e.g., selection between 1080por 4K and/or stereoscopic). In addition, the controls 305 a and/or 305 bmay be used to initiate and/or perform a calibration procedure and/ormove a robotic arm connected to the stereoscopic visualization camera300. In some instances, the controls 305 a and 305 b may include thesame buttons and/or features. In other instances the controls 305 a and305 b may include different features. Further, the control arms 304 aand 304 b may also be configured as grips to enable an operator toposition the stereoscopic visualization camera 300.

Each control arm 304 is connected to the housing 302 via a rotatablepost 306, as shown in FIG. 3. This connection enables the control arms304 to be rotated with respect to the housing 302. This rotationprovides flexibility to a surgeon to arrange the control arms 304 asdesired, further enhancing the adaptability of the stereoscopicvisualization camera 300 to be in synchronization with a surgicalperformance.

While the example camera 300 shown in FIGS. 3 and 4 includes two controlarms 304 a and 304 b, it should be appreciated that the camera 300 mayonly include one control arm or zero control arms. In instances wherethe stereoscopic visualization camera 300 does not include a controlarm, controls may be integrated with the housing 302 and/or provided viaa remote control.

FIG. 4 shows a bottom-up perspective view of a rear-side of thestereoscopic visualization camera 300, according to an exampleembodiment of the present disclosure. The stereoscopic visualizationcamera 300 includes a mounting bracket 402 configured to connect to asupport. As described in more detail in FIGS. 5 and 6, the support mayinclude an arm with one or more joints to provide significantmaneuverability. The arm may be connected to a moveable cart or securedto a wall or ceiling.

The stereoscopic visualization camera 300 also includes a power port 404configured to receive a power adapter. Power may be received from an ACoutlet and/or a battery on a cart. In some instances, the stereoscopicvisualization camera 300 may include an internal battery to facilitateoperation without cords. In these instances, the power port 404 may beused to charge the battery. In alternative embodiments, the power port404 may be integrated with the mounting bracket 402 such that thestereoscopic visualization camera 300 receives power via wires (or otherconductive routing materials) within the support.

FIG. 4 also shows that the stereoscopic visualization camera 300 mayinclude a data port 406. The example data port 406 may include any typeof port including, for example, an Ethernet interface, a high-definitionmultimedia interface (“HDMI”) interface, a universal serial bus (“USB”)interface, a Serial Digital Interface (“SDI”), a digital opticalinterface, an RS-232 serial communication interface etc. The data port406 is configured to provide a communicative connection between thestereoscopic visualization camera 300 and cords routed to one or morecomputing devices, servers, recording devices, and/or display devices.The communicative connection may transmit stereoscopic video signals ortwo-dimensional video signals for further processing, storage, and/ordisplay. The data port 406 may also enable control signals to be sent tothe stereoscopic visualization camera 300. For instance, an operator ata connected computer (e.g., a laptop computer, desktop computer, and/ortablet computer) may transmit control signals to the stereoscopicvisualization camera 300 to direct operation, perform calibration, orchange an output display setting.

In some embodiments, the data port 406 may be replaced (and/orsupplemented) with a wireless interface. For example, the stereoscopicvisualization camera 300 may transmit stereoscopic display signals viaWi-Fi to one or more display devices. A use of a wireless interface,combined with an internal battery, enables the stereoscopicvisualization camera 300 to be wire-free, thereby further improvingmaneuverability within a surgical environment.

The stereoscopic visualization camera 300 shown in FIG. 4 also includesa front working distance main objective lens 408 of a main objectiveassembly. The example lens 408 is the start of the optical path withinthe stereoscopic visualization camera 300. Light from a light sourceinternal to the stereoscopic visualization camera 300 is transmittedthrough the lens 408 to a target site. Additionally, light reflectedfrom the target site is received in the lens 408 and passed todownstream optical elements.

II. Exemplary Maneuverability of the Stereoscopic Visualization Camera

FIGS. 5 and 6 show diagrams of the stereoscopic visualization camera 300used within a microsurgical environment 500, according to exampleembodiments of the present disclosure. As illustrated, the smallfootprint and maneuverability of the stereoscopic visualization camera300 (especially when used in conjunction with a multiple-degree offreedom arm) enables flexible positioning with respect to a patient 502.A portion of the patient 502 in view of the stereoscopic visualizationcamera 300 includes a target site 503. A surgeon 504 can position thestereoscopic visualization camera 300 in virtually any orientation whileleaving more than sufficient surgical space above the patient 502 (lyingin the supine position). The stereoscopic visualization camera 300accordingly is minimally intrusive (or not intrusive) to enable thesurgeon 504 to perform a life-altering microsurgical procedure withoutdistraction or hindrance.

In FIG. 5, the stereoscopic visualization camera 300 is connected to amechanical arm 506 via mounting bracket 402. The arm 506 may include oneor more rotational or extendable joints with electromechanical brakes tofacilitate easy repositioning of the stereoscopic visualization camera300. To move the stereoscopic visualization camera 300, the surgeon 504,or the assistant 508, actuates brake releases on one or more joints ofthe arm 506. After the stereoscopic visualization camera 300 is movedinto a desired position, the brakes may be engaged to lock the joints ofthe arm 506 in place.

A significant feature of the stereoscopic visualization camera 300 isthat it does not include oculars. This means that the stereoscopicvisualization camera 300 does not have to be aligned with the eyes ofthe surgeon 504. This freedom enables the stereoscopic visualizationcamera 300 to be positioned and orientated in desirable positions thatwere not practical or possible with prior known surgical microscopes. Inother words, the surgeon 504 can perform microsurgery with the mostoptimal view for conducting the procedure rather than being restrictedto merely adequate view dictated by oculars of a surgical microscope.

Returning to FIG. 5, the stereoscopic visualization camera 300, via themechanical arm 506, is connected to a cart 510 with display monitors 512and 514 (collectively a stereoscopic visualization platform 516). In theillustrated configuration, the stereoscopic visualization platform 516is self-contained and may be moved to any desired location in themicrosurgical environment 500 including between surgical rooms. Theintegrated platform 516 enables the stereoscopic visualization camera300 to be moved and used on-demand without time needed to configure thesystem by connecting the display monitors 512 and 514.

The display monitors 512 and 514 may include any type of displayincluding a high-definition television, an ultra-high definitiontelevision, smart-eyewear, projectors, one or more computer screens,laptop computers, tablet computers, and/or smartphones. The displaymonitors 512 and 514 may be connected to mechanical arms to enableflexible positioning similar to the stereoscopic visualization camera300. In some instances, the display monitors 512 and 514 may include atouchscreen to enable an operator to send commands to the stereoscopicvisualization camera 300 and/or adjust a setting of a display.

In some embodiments, the cart 516 may include a computer 520. In theseembodiments, the computer 520 may control a robotic mechanical armconnected to the stereoscopic visualization camera 300. Additionally oralternatively, the computer 520 may process video (or stereoscopicvideo) signals (e.g., an image or frame stream) from the stereoscopicvisualization camera 300 for display on the display monitors 512 and514. For example, the computer 520 may combine or interleave left andright video signals from the stereoscopic visualization camera 300 tocreate a stereoscopic signal for displaying a stereoscopic image of atarget site. The computer 520 may also be used to store video and/orstereoscopic video signals into a video file (stored to a memory) so thesurgical performance can be documented and played back. Further, thecomputer 520 may also send control signals to the stereoscopicvisualization camera 300 to select settings and/or perform calibration.

In some embodiments, the microsurgical environment 500 of FIG. 5includes an ophthalmic surgery procedure. In this embodiment, themechanical arm 506 may be programmed to perform an orbiting sweep of apatient's eye. Such a sweep enables the surgeon to examine a peripheralretina during vitreo-retinal procedures. In contrast, with conventionaloptical microscopes, the only way a surgeon can view the peripheralretina is to push the side of the eye into the field of view using atechnique known as scleral depression.

FIG. 6 shows a diagram of the microsurgical environment 500 with thepatient 502 in a sitting position for a posterior-approach skull baseneurosurgery. In the illustrated embodiment, the stereoscopicvisualization camera 300 is placed into a horizontal position to facethe back of the head of the patient 502. The mechanical arm 506 includesjoints that enable the stereoscopic visualization camera 300 to bepositioned as shown. In addition, the cart 510 includes the monitor 512,which may be aligned with the surgeon's natural view direction.

The absence of oculars enables the stereoscopic visualization camera 300to be positioned horizontally and lower than the eye-level view of thesurgeon 504. Further, the relatively low weight and flexibility enablesthe stereoscopic visualization camera 300 to be positioned in waysunimaginable for other known surgical microscopes. The stereoscopicvisualization camera 300 thereby provides a microsurgical view for anydesired position and/or orientation of the patient 502 and/or thesurgeon 504.

While FIGS. 5 and 6 show two example embodiments for positioning thestereoscopic visualization camera 300, it should be appreciated that thestereoscopic visualization camera 300 may be positioned in any number ofpositions depending on the number of degrees of freedom of themechanical arm 506. It is entirely possible in some embodiments toposition the stereoscopic visualization camera 300 to face upwards(e.g., upside down).

III. Comparison of the Example Stereoscopic Visualization Platform toKnown Surgical Microscopes

In comparing the stereoscopic visualization camera 300 of FIGS. 3 to 6to the surgical microscope 200 of FIG. 2, the differences are readilyapparent. The inclusion of oculars 206 with the surgical microscoperequires that the surgeon constantly orient his/her eyes to eyepieces,which are in a fixed location relative to the scope head 201 andpatient. Further, the bulkiness and weight of the surgical microscoperestricts it to being positioned only in a generally verticalorientation with respect to a patient. In contrast, the examplestereoscopic visualization camera 300 does not include oculars and maybe positioned in any orientation or position with respect to a patient,thereby freeing the surgeon to move during surgery.

To enable other clinician staff to view a microsurgical target site, thesurgical microscope 200 requires the addition of second oculars 208.Generally, most known surgical microscopes 200 do not allow adding thirdoculars. In contrast, the example stereoscopic visualization camera 300may be communicatively coupled to an unlimited number of displaymonitors. While FIGS. 5 and 6 above showed display monitors 512 and 514connected to cart 510, a surgical room may be surrounded in displaymonitors that all show the microsurgical view recorded by thestereoscopic visualization camera 300. Thus, instead of limiting a viewto one or two people (or requiring sharing an ocular), an entiresurgical team can view a magnified view of a target surgical site.Moreover, people in other rooms, such as training and observation rooms,can be presented with the same magnified view displayed to the surgeon.

Compared to the stereoscopic visualization camera 300, the two-ocularsurgical microscope 200 is more prone to being bumped or inadvertentlymoved. Since surgeons place their heads on oculars 206 and 208 duringsurgery to look through eyepieces, the scope head 201 receives constantforce and periodic bumps. Adding the second oculars 208 doubles theforce from a second angle. Altogether, the constant force and periodicbumping by the surgeons may cause the scope head 201 to move, therebyrequiring the scope head 201 to be repositioned. This repositioningdelays the surgical procedure and annoys the surgeon.

The example stereoscopic visualization camera 300 does not includeoculars and is not intended to receive contact from a surgeon once it islocked into place. This corresponds to a significantly lower chance ofthe stereoscopic visualization camera 300 being accidently moved orbumped during the surgeon's performance.

To facilitate the second oculars 208, the surgical microscope 200 has tobe outfitted with a beamsplitter 210, which may include glass lenses andmirrors housed in precision metallic tubes. The use of a beamsplitter210 reduces light received at the first oculars because some of thelight is reflected to the second oculars 208. Further, addition of thesecond oculars 208 and the beamsplitter 210 increases the weight andbulkiness of the scope head 201.

In contrast to the surgical microscope 200, the stereoscopicvisualization camera 300 only contains optical paths for sensors,thereby reducing weight and bulkiness. In addition, the optical sensorsreceive the full incident light since beamsplitters are not needed toredirect a portion of the light. This means the image received byoptical sensors of the example stereoscopic visualization camera 300 isas bright and clear as possible.

Some models of surgical microscopes may enable a video camera to beattached. For instance, the surgical microscope 200 of FIG. 2 includes amonoscopic video camera 212 connected to an optical path viabeamsplitter 214. The video camera 212 may be monoscopic orstereoscopic, such as the Leica® TrueVision® 3D Visualization SystemOphthalmology camera. The video camera 212 records an image receivedfrom the beamsplitter 214 for display on a display monitor. The additionof the video camera 212 and beamsplitter 214 further add to the weightof the scope head 201. In addition, the beamsplitter 214 consumesadditional light destined for the oculars 206 and/or 208.

Each beamsplitter 210 and 214 divides the incident light fractionallyinto three paths, removing light from the surgeon's view. The surgeon'seye has limited low-light sensitivity such that light from the operativesite presented to him/her must be sufficient to allow the surgeon toperform the procedure. However, a surgeon cannot always increase theintensity of light applied to a target site on a patient, especially inopthalmological procedures. A patient's eye has limited high-lightsensitivity before it develops light toxicity. Hence, there is alimitation to the number and fraction of beamsplitters and to the amountof light which can be split off from the first oculars 206 to enable theuse of ancillary devices 208 and 212.

The example stereoscopic visualization camera 300 of FIGS. 3 to 6 doesnot include beamsplitters such that optical imaging sensors receive thefull amount of light from a main objective assembly. This enables theuse of sensors with low-light sensitivity or even optical sensors withsensitivity outside the wavelengths of visible light to be used sincepost-processing can make the images sufficiently bright and visible (andadjustable) for display on the monitors.

Further, since the optical elements that define the optical paths areself-contained within the stereoscopic visualization camera 300, theoptical elements may be controlled through the camera. This controlallows placement and adjustment of the optical elements to be optimizedfor a three-dimensional stereoscopic display rather than for microscopeoculars. This configuration of the camera permits control to be providedelectronically from camera controls or from a remote computer. Inaddition, the control may be provided automatically through one or moreprograms onboard the camera 300 configured to adjust optical elementsfor retaining focus while zooming or to adjust for optical defectsand/or spurious parallax. In contrast, optical elements of the surgicalmicroscope 200 are external to the video camera 212 and controlled onlyvia operator input, which is generally optimized for viewing a targetsite through the oculars 206.

In a final comparison, the surgical microscope 200 includes an X-Ypanning device 220 for moving a field-of-view or target scene. The X-Ypanning device 220 is typically a large, heavy, and expensiveelectromechanical module since it must rigidly support and move thesurgical scope head 201. In addition, moving the scope head 201 changesthe positioning of the surgeon to the new location of the oculars 206.

In contrast, the example stereoscopic visualization camera 300 includesa memory including instructions, which when executed, cause a processorto select pixel data of optical sensors to enable X-Y panning across awide pixel grid. In addition, the example stereoscopic visualizationcamera 300 may include a small motor or actuator that controls a mainobjective optical element to change a working distance to a target sitewithout moving the camera 300.

IV. Example Optical Elements of the Stereoscopic Visualization Camera

FIGS. 7 and 8 show diagrams illustrative of optical elements within theexample stereoscopic visualization camera 300 of FIGS. 3 to 6, accordingto an example embodiment of the present disclosure. It may seemrelatively simple to acquire left and right views of a target site toconstruct a stereoscopic image. However, without careful design andcompensation, many stereoscopic images have alignment issues between theleft and right views. When viewed for a prolonged period of time,alignment issues can create confusion in an observer's brain as a resultof differences between the left and right views. This confusion can leadto headaches, fatigue, vertigo, and even nausea.

The example stereoscopic visualization camera 300 reduces (oreliminates) alignment issues by having a right optical path and leftoptical path with independent control and/or adjustment of some opticalelements while other left and right optical elements are fixed in acommon carrier. In an example embodiment, some left and right zoomlenses may be fixed to a common carrier to ensure left and rightmagnification is substantially the same. However, front or rear lensesmay be independently adjustable radially, rotationally, axially, and/ortilted to compensate for small differences in zoom magnification, visualdefects, and/or spurious parallax such as movement of a zoom repeatpoint. Compensation provided by adjustable lenses results in almostperfectly aligned optical paths throughout a complete zoom magnificationrange.

Additionally or alternatively, alignment issues may be reduced (oreliminated) using pixel readout and/or rendering techniques. Forexample, a right image (recorded by a right optical sensor) may beadjusted upwards or downwards with respect to a left image (recorded bya left optical sensor) to correct vertical misalignment between theimages. Similarly, a right image may be adjusted left or right withrespect to a left image to correct horizontal misalignment between theimages.

FIGS. 7 and 8 below show an example arrangement and positioning ofoptical elements that provide for almost artifact, spurious parallax,and distortion-free aligned optical paths. As discussed later, certainof the optical elements may be moved during calibration and/or use tofurther align the optical paths and remove any remaining distortions,spurious parallax, and/or defects. In the illustrated embodiment, theoptical elements are positioned in two parallel paths to generate a leftview and a right view. Alternative embodiments may include optical pathsthat are folded, deflected or otherwise not parallel.

The illustrated paths correspond to a human's visual system such thatthe left view and right view, as displayed on a stereoscopic display,appear to be separated by a distance that creates a convergence angle ofroughly 6 degrees, which is comparable to the convergence angle for anadult human's eyes viewing an object at approximately 4 feet away,thereby resulting in stereopsis. In some embodiments, image datagenerated from the left view and right view are combined together on thedisplay monitor(s) 512 and 514 to generate a stereoscopic image of atarget site or scene. Alternative embodiments comprise otherstereoscopic displays where the left view is presented to only the lefteye of a viewer and the corresponding right view is presented to onlythe right eye. In exemplary embodiments used to adjust and verify properalignment and calibration, both views are displayed overlaid to botheyes.

A stereoscopic view is superior to a monoscopic view because it mimicsthe human visual system much more closely. A stereoscopic view providesdepth perception, distance perception, and relative size perception toprovide a realistic view of a target surgical site to a surgeon. Forprocedures such as retinal surgery, stereoscopic views are vital becausesurgical movements and forces are so small that the surgeon cannot feelthem. Providing a stereoscopic view helps a surgeon's brain magnifytactile feel when the brain senses even minor movements while perceivingdepth.

FIG. 7 shows a side view of the example stereoscopic visualizationcamera 300 with the housing 302 being transparent to expose the opticalelements. FIG. 8 shows a diagram illustrative of an optical pathprovided by the optical elements shown in FIG. 7. As shown in FIG. 8,the optical path includes a right optical path and a left optical path.The optical paths in FIG. 8 are shown from a perspective of facing aforward direction and looking down at the stereoscopic visualizationcamera 300. From this view, the left optical path appear on the rightside of FIG. 8 while the right optical path is shown on the left side.

The optical elements shown in FIG. 7 are part of the left optical path.It should be appreciated that the right optical path in FIG. 7 isgenerally identical to the left optical path regarding relation locationand arrangement of optical elements. As mentioned above, theinterpupillary distance between a center of the optical paths is between58 to 70 mm, which may be scaled to 10 to 25 mm. Each of the opticalelements comprise lenses having certain diameters (e.g., between 2 mmand 29 mm). Accordingly, a distance between the optical elementsthemselves is between 1 to 23 mm, preferably around 10 mm.

The example stereoscopic visualization camera 300 is configured toacquire images of a target site 700 (also referred to as a scene orfield-of-view). The target site 700 includes an anatomical location on apatient. The target site 700 may also include laboratory biologicalsamples, calibration slides/templates, etc. Images from the target site700 are received at the stereoscopic visualization camera 300 via a mainobjective assembly 702, which includes the front working distance lens408 (shown in FIG. 4) and a rear working distance lens 704.

A. Example Main Objective Assembly

The example main objective assembly 702 may include any type ofrefractive assembly or reflective assembly. FIG. 7 shows the objectiveassembly 702 as an achromatic refractive assembly with the front workingdistance lens 408 being stationary and the rear working distance lens704 being movable along the z-axis. The front working distance lens 408may comprise a plano convex (“PCX”) lens and/or a meniscus lens. Therear working distance lens 704 may comprise an achromatic lens. Inexamples where the main objective assembly 702 includes an achromaticrefractive assembly, the front working distance lens 408 may include ahemispherical lens and/or a meniscus lens. In addition, the rear workingdistance lens 704 may include an achromatic doublet lens, an achromaticdoublet group of lenses, and/or an achromatic triplet lens.

The magnification of the main objective assembly 702 is between 6× to20×. In some instances, the magnification of the main objective assembly702 may vary slightly based on a working distance. For example, the mainobjective assembly 702 may have a magnification of 8.9× for a 200 mmworking distance and a magnification of 8.75× for a 450 mm workingdistance.

The example rear working distance lens 704 is configured to be moveablewith respect to the front working distance lens 408 to change a spacingtherebetween. The spacing between the lenses 408 and 704 determines theoverall front focal length of the main objective assembly 702, andaccordingly the location of a focal plane. In some embodiments, thefocal length is the distance between the lenses 408 and 704 plusone-half the thickness of the front working distance lens 408.

Together, the front working distance lens 408 and the rear workingdistance lens 704 are configured to provide an infinite conjugate imagefor providing an optimal focus for downstream optical image sensors. Inother words, an object located exactly at the focal plane of the targetsite 700 will have its image projected at a distance of infinity,thereby being infinity-coupled at a provided working distance.Generally, the object appears in focus for a certain distance along theoptical path from the focal plane. However, past the certain thresholddistance, the object begins to appear fuzzy or out of focus.

FIG. 7 shows working distance 706, which is the distance between anouter surface of the front working distance lens 408 and to the focalplane of the target site 700. The working distance 706 may correspond toan angular field-of-view, where a longer working distance results in awider field-of-view or larger viewable area. The working distance 706accordingly sets a plane of the target site or scene that is in focus.In the illustrated example, the working distance 706 is adjustable from200 to 450 mm by moving the rear working distance lens 704. In anexample, the field-of-view can be adjusted between 20 mm×14 mm to 200mm×140 mm using upstream zooming lenses when the working distance is 450mm.

The main objective assembly 702 shown in FIGS. 7 and 8 provides an imageof the target site 700 for both the left and right optical paths. Thismeans that the width of the lenses 408 and 704 should be at least aswide as the left and right optical paths. In alternative embodiments,the main objective assembly 702 may include separate left and rightfront working distance lenses 408 and separate left and right rearworking distance lens 704. The width of each pair of the separateworking distance lenses may be between ¼ to ½ of the width of the lenses408 and 704 shown in FIGS. 7 and 8. Further, each of the rear workingdistance lenses 704 may be independently adjustable.

In some embodiments, the main objective assembly 702 may be replaceable.For example, different main objective assemblies may be added to changea working distance range, a magnification, a numerical aperture, and/orrefraction/reflection type. In these embodiments, the stereoscopicvisualization camera 300 may change positioning of downstream opticalelements, properties of optical image sensors, and/or parameters ofimage processing based on which main objective assembly is installed. Anoperator may specify which main objective assembly is installed in thestereoscopic visualization camera 300 using one of the controls 305 ofFIG. 3 and/or a user input device.

B. Example Lighting Sources

To illuminate the target site 700, the example stereoscopicvisualization camera 300 includes one or more lighting sources. FIGS. 7and 8 show three lighting sources including a visible light source 708a, a near-infrared (“NIR”) light source 708 b, and a near-ultraviolet(“NUV”) light source 708 c. In other examples, the stereoscopicvisualization camera 300 may include additional or fewer (or no) lightsources. For instance, the NIR and NUV light sources may be omitted. Theexample light sources 708 are configured to generate light, which isprojected to the target scene 700. The generated light interacts andreflects off the target scene, with some of the light being reflected tothe main objective assembly 702. Other examples may include externallight sources or ambient light from the environment.

The example visible light source 708 a is configured to output light inthe human-visible part of the light spectrum in addition to some lightwith wavelengths outside the visible region. The NIR light source 708 bis configured to output light that is primarily at wavelengths slightlypast the red part of the visible spectrum, which is also referred to as“near-infrared.” The NUV light source 708 c is configured to outputlight that is primarily at wavelengths in the blue part of the visiblespectrum, which is referred to as “near-ultraviolet.” The light spectraoutput by the light sources 708 is controlled by respective controllers,described below. A brightness of light emitted by the light sources 708may be controlled by a switching rate and/or applied voltage waveform.

FIGS. 7 and 8 illustrate that the visible light source 708 a and the NIRlight source 708 b are provided directly through the main objectiveassembly 702 to the target site 700. As shown in FIG. 8, visible lightfrom the visible light source 708 a propagates along visible path 710 a.Additionally, NIR light from the NIR light source 708 b propagates alongNIR path 710 b. While the light sources 708 a and 708 b are shown asbeing behind the main objective assembly 702 (with respect to the targetsite 700), in other examples the light sources 708 a and 708 b may beprovided before the main objective assembly 702. In one embodiment, thelight sources 708 a and 708 b may be provided on an outside of thehousing 302 and face toward the target site 700. In yet otherembodiments, the light sources 708 may be provided separate from thestereoscopic visualization camera 300 using, for example, a Koeherillumination setup and/or a darkfield illumination setup.

In contrast to the light sources 708 a and 708 b, NUV light from the NUVlight source 708 c is reflected by a deflecting element 712 (e.g., abeamsplitter) to the main objective assembly 702 using anepi-illumination setup. The deflecting element 712 may be coated orotherwise configured to reflect only light beyond the NUV wavelengthrange, thereby filtering NUV light. NUV light from the NUV light source708 c propagates along NUV path 710 c.

In some embodiments, the NIR and NUV light sources 708 b and 708 c maybe used with excitation filters to further filter light that may not beblocked by filters (e.g., filter 740). The filters may be placed infront of the light sources 708 b and 708 c before the main objectiveassembly 702 and/or after the main objective assembly. The light fromthe NUV and NIR light sources 708 b and 708 c, after being filtered,comprises wavelengths that excite fluorescence in fluorescent sites 914(shown in FIG. 9) of an anatomical object. Further, the light from theNUV and NIR light sources 708 b and 708 c, after being filtered, maycomprise wavelengths that are not in the same range as those beingemitted by the fluorescent sites 914.

The projection of the light from light sources 708 through the mainobjective assembly provides the benefit of changing the lightedfield-of-view based on the working distance 706 and/or focal plane.Since the light passes through the main objective assembly 702, theangle at which light is projected changes based on the working distance706 and corresponds to the angular field-of-view. This configurationaccordingly ensures the field-of-view is properly illuminated by thelight sources 708, regardless of working distance or magnification.

C. Example Deflecting Element

The example deflecting element 712 illustrated in FIGS. 7 and 8 isconfigured to transmit a certain wavelength of light from the NUV lightsource 708 c to the target site 700 through the main objective assembly702. The deflecting element 712 is also configured to reflect lightreceived from the target site 700 to downstream optical elements,including a front lens set 714 for zooming and recording. In someembodiments, the deflecting element 712 may filter light received fromthe target site 700 through the main objective assembly 702 so thatlight of certain wavelengths reaches the front lens set 714.

The deflecting element 712 may include any type of mirror or lens toreflect light in a specified direction. In an example, the deflectingelement 712 includes a dichroic mirror or filter, which has differentreflection and transmission characteristics at different wavelengths.The stereoscopic visualization camera 300 of FIGS. 7 and 8 includes asingle deflecting element 712, which provides light for both the rightand left optical paths. In other examples, the camera 300 may includeseparate deflecting elements for each of the right and left opticalpaths. Further, a separate deflecting element may be provided for theNUV light source 708 c.

FIG. 9 shows a diagram of the deflecting element 712 of FIGS. 7 and 8,according to an example embodiment of the present disclosure. Forbrevity, the main objective assembly 702 is not shown. In this example,the deflecting element 712 includes two parallel faces 902 and 904 fortransmitting and reflecting light of certain wavelengths. The parallelfaces 902 and 904 are set at a 45° angle with respect to the left andright optical paths (represented as path 906). The 45° angle is selectedsince this angle causes reflected light to propagate at a 90° angle fromthe transmitted light, thereby providing optimal separation withoutcausing the separated light to be detected in the downstream front lensset 714. In other embodiments, the angle of the deflecting element 712could be between 10 degrees and 80 degrees without unintentionallypropagating light of unwanted wavelengths.

The example NUV light source 708 c is located behind the deflectingelement 712 (with respect to the target site 700). Light from the lightsource 708 c propagates along path 908 and contacts the deflectingelement 712. NUV light around the primary wavelength range of the NUVlight source 708 c is transmitted through the deflecting element 712along path 910 to the target site 700. Light from the NUV light source708 c that has a wavelength above (and below) the primary wavelengthrange of the NUV light source 708 c is reflected along path 912 to alight sink or unused region of the housing 302.

When the NUV light reaches the target site 700, it is absorbed by one ormore fluorescent sites 914 of an anatomical object. In some instances,the anatomical object may have been injected with a contrast agentconfigured to absorb NUV light and emit light with a different primarywavelength. In other instances, the anatomical object may naturallyabsorb NUV light and emit light with a different primary wavelength. Atleast some of the light reflected or emitted by the fluorescent site 914propagates along path 916 until it contacts the deflecting element 712.Most of the light reflects off the surface 904 along path 906 to thefront lens set 714. A portion of the light, including NUV light aroundthe primary wavelength range of the NUV light source 708 c istransmitted through the deflecting element 712 along path 918 to a lightsink or unused region of the housing 302. The deflecting element 712shown in FIG. 9 accordingly enables optical stimulation of a fluorescentagent at the target site 700 with one region of the spectrum whileblocking much of the stimulating light from travelling to the downstreamfront lens set 714.

It should be appreciated that the reflectivity and transmissivitycharacteristics of the deflecting element 712 can be changed to meetother light spectrum requirements. In some instances, the housing 302may include a slot that enables the deflecting element 712 and/or theNUV light source 708 c to be replaced based on the desired lightreflectivity and transmissivity characteristics. It should also beappreciated that a first path internal to the deflecting element 712between path 908 and path 910 and a second path internal to thedeflecting element 712 between path 916 and path 918 are each angled torepresent schematically the refraction of the light as it travelsbetween air and the interior of the deflecting element 712. The anglesshown are not meant to represent actual reflection angles.

D. Example Zoom Lenses

The example stereoscopic visualization camera 300 of FIGS. 7 and 8includes one or more zoom lens to change a focal length and angle ofview of the target site 700 to provide zoom magnification. In theillustrated example, the zoom lens includes the front lens set 714, azoom lens assembly 716, and a lens barrel set 718. It should beappreciated that in other embodiments, the front lens set 714 and/or thelens barrel set 718 may be omitted. Alternatively, the zoom lens mayinclude additional lens to provide further magnification and/or imageresolution.

The front lens set 714 includes a right front lens 720 for the rightoptical path and a left front lens 722 for the left optical path. Thelenses 720 and 722 may each include a positive converging lens to directlight from the deflecting element 712 to respective lenses in the zoomlens assembly 716. A lateral position of the lenses 720 and 722accordingly defines a beam from the main objective assembly 702 and thedeflecting element 712 that is propagated to the zoom lens assembly 716.

One or both of the lenses 720 and 722 may be adjustable radially tomatch optical axes of the left and right optical paths. In other words,one or both of the lenses 720 and 722 may be moved left-right and/orup-down in a plane incident to the optical path. In some embodiments,one or more of the lenses 720 and 722 may be rotated or tilted to reduceor eliminate image optical defects and/or spurious parallax. Movingeither or both of the lenses 720 and 722 during zooming may cause thezoom repeat point (“ZRP”) for each optical path to appear to remainstationary to a user. In addition to radial movement, one or both of thefront lenses 720 and 722 may be moved axially (along the respectiveoptical path) to match magnifications of the optical paths.

The example zoom lens assembly 716 forms an afocal zoom system forchanging the size of a field-of-view (e.g., a linear field-of-view) bychanging a size of the light beam propagated to the lens barrel set 718.The zoom lens assembly 716 includes a front zoom lens set 724 with aright front zoom lens 726 and a left front zoom lens 728. The zoom lensassembly 716 also includes a rear zoom lens set 730 with a right rearzoom lens 732 and a left rear zoom lens 734. The front zoom lenses 726and 728 may be positive converging lenses while the rear zoom lenses 732and 734 include negative diverging lenses.

The size of an image beam for each of the left and right optical pathsis determined based on a distance between the front zoom lenses 726 and728, the rear zoom lenses 732 and 734 and the lens barrel set 718.Generally, the size of the optical paths reduces as the rear zoom lenses732 and 734 move toward the lens barrel set 718 (along the respectiveoptical paths), thereby decreasing magnification. In addition, the frontzoom lenses 726 and 728 may also move toward (or away from) the lensbarrel set 718 (such as in a parabolic arc), as the rear zoom lenses 732and 734 move toward the lens barrel set 718, to maintain the location ofthe focal plane on the target site 700, thereby maintaining focus.

The front zoom lenses 726 and 728 may be included within a first carrier(e.g., the front zoom set 724) while the rear zoom lenses 732 and 724are included within a second carrier (e.g., the rear zoom set 730). Eachof the carriers 724 and 730 may be moved on tracks (or rails) along theoptical paths such that left and right magnification changesconcurrently. In this embodiment, any slight differences inmagnification between the left and right optical paths may be correctedby moving the right front lens 720 and/or the left front lens 722.Additionally or alternatively, a right lens barrel 736 and/or a leftlens barrel 738 of the lens barrel set 718 may be moved axially.

In alternative embodiments, the right front zoom lens 726 may be movedaxially separately from the left front zoom lens 728. In addition, theright rear zoom lens 732 may be moved axially separately from the leftrear zoom lens 734. Separate movement may enable small magnificationdifferences to be corrected by the zoom lens assembly 716, especiallywhen the front lens set 714 and the lens barrel set 718 are stationaryalong the optical paths. Further, in some embodiments, the right frontzoom lens 726 and/or the left front zoom lens 728 may be radially and/orrotationally adjustable (and/or tilted) to maintain an apparent locationof a ZRP in the optical path. Additionally or alternatively, the rightrear zoom lens 732 and/or the left rear zoom lens 734 may be radiallyand/or rotationally adjustable (and/or tilted) to maintain an apparentlocation of a ZRP in the optical path.

The example lens barrel set 718 includes the right lens barrel 736 andthe left lens barrel 738, which are part of the afocal zoom system inaddition with the zoom lens assembly 716. The lenses 736 and 738 mayinclude positive converging lenses configured to straighten or focus alight beam from the zoom lens assembly 716. In other words, the lenses736 and 738 focus the infinity-coupled output of the zoom lens assembly716.

In some examples, the lens barrel set 718 is fixed radially and axiallywithin the housing 302. In other examples, the lens barrel set 718 maybe moveable axially along the optical path to provide increasedmagnification. Additionally or alternatively, each of the lenses 736 and738 may be radially and/or rotationally adjustable (and/or tilted) to,for example, correct for differences in optical properties (frommanufacturing or natural glass deviations) between the left and rightlenses of the front lens set 714, the front zoom lens set 724, and/orthe rear zoom lens set 730.

Altogether, the example front lens set 714, the zoom lens assembly 716,and the lens barrel set 718 are configured to achieve an optical zoombetween 5× to about 20×, preferably at a zoom level that hasdiffraction-limited resolution. In some embodiments, the front lens set714, the zoom lens assembly 716, and the lens barrel set 718 may providehigher zoom ranges (e.g., 25X to 100X) if image quality can becompromised. In these embodiments, the stereoscopic visualization camera300 may output a message to an operator indicative that a selectedoptical range is outside of an optical range and subject to a reductionin image quality.

In some embodiments, the lenses of the front lens set 714, the zoom lensassembly 716, the lens barrel set 718, and/or the main objectiveassembly 702 may each be constructed as a doublet from multiple opticalsub-elements using materials that balance each other's opticaldistortion parameters. The doublet construction reduces chromaticaberrations and optical aberrations. For example, the front workingdistance lens 408 and the rear working distance lens 702 may each beconstructed as a doublet. In another example, the front lenses 720 and722, the front zoom lenses 726 and 728, the rear zoom lenses 732 and734, and the lens barrels 736 and 738 may each comprise a doublet lens.

In yet further embodiments, the lenses of the front lens set 714, thezoom lens assembly 716, the lens barrel set 718, and/or the mainobjective assembly 702 may be tuned differently and/or have differentproperties to provide two parallel optical paths with differentcapabilities. For example, right lenses in zoom lens assembly 716 may beselected to provide 5× to 10× optical zoom for the right optical pathwhile left lenses in the zoom lens assembly 716 are selected to provide15× to 20× optical zoom for the left optical path. Such a configurationmay enable two different magnifications to be shown at the same timeand/or on the same screen, though in a monoscopic view.

E. Example Filter

The example stereoscopic visualization camera 300 of FIGS. 7 and 8includes one or more optical filters 740 (or filter assemblies) toselectively transmit desired wavelengths of light. FIG. 8 shows that asingle filter 740 may be applied to the right and left optical paths. Inother examples, each of the optical paths may have a separate filter.The inclusion of separate filters enables, for example, differentwavelengths of light to be filtered from the left and right opticalpaths at the same time, which enables, for example, fluorescent imagesto be displayed in conjunction with visible light images.

FIG. 7 shows that the filter 740 includes a magazine that is rotatedabout its axis of rotation. In the illustrated embodiment, the filter740 can accommodate three different optical filter pairs. However, inother embodiments, the filter 740 may include additional or fewer filterpairs. Generally, light received at the filter 740 from the target site700 includes a broad spectrum of wavelengths. The lenses of the mainobjective assembly 702, the front lens set 714, the zoom lens assembly716, and the lens barrel set 718 are configured to pass a relativelywide bandwidth of light including wavelengths of interest to an operatorand undesirable wavelengths. In addition, downstream optical imagesensors are sensitive to certain wavelengths. The example filter 740accordingly passes and blocks certain portions of the light spectrum toachieve different desirable features.

As a magazine, the filter 740 comprises a mechanical device capable ofchanging positions at about four times per second. In other embodiments,the filter 740 may include a digital micro-mirror, which can change alight path's direction at video frame rates such as 60 times per second.In these other embodiments, each of the left and right optical pathswould include a micro-mirror. The left and right micro-mirror may havesynchronized or simultaneous switching.

In some embodiments, the filter 740 may be synchronized to the lightsources 708 to realize “time-interleaved” multispectral imaging. Forexample, the filter 740 may include an infrared cut filter,near-infrared bandpass filter, and near-ultraviolet cut filter. Thedifferent filter types are selected to work with different spectra ofthe light sources 708 and the reflectivity and transmissivitycharacteristics of the deflecting element 712 to pass certain desiredwavelengths of light at predetermined times.

In one mode, the filter 740 and the light sources 708 are configured toprovide a visible light mode. In this mode, the visible light source 708a transmits light from the visible region onto the target site 700, someof which is reflected to the main objective assembly 702. The reflectedlight may include some light beyond the visible spectrum, which mayaffect optical image sensors. The visible light is reflected by thedeflecting element 712 and passes through the front lens set 714, thezoom lens assembly 716, and the lens barrel set 718. In this example,the filter 740 is configured to apply the infrared cut filter or thenear-ultraviolet cut filter to the optical paths to remove light outsidethe visible spectrum such that light only in the visible spectrum passesthrough to a final optical set 742 and an optical image sensor 744.

In another mode, filter 740 and the light sources 708 are configured toprovide fluorescence light of a narrow wavelength to the optical sensor744. In this mode, the NUV light source 708 c transmits light from thedeep-blue region of the spectrum to the target site 700. The deflectingelement 712 allows the desired light of the deep-blue region to passthrough while reflecting undesired light. The deep-blue light interactswith the target site 700 such that fluorescence light is emitted. Insome examples, δ-Aminolaevulinic acid (“Sala”) and/or Protoporphyrin IXis applied to the target site 700 to cause fluorescence light to beemitted when deep-blue light is received. The main objective assembly702 receives the fluorescence light in addition to reflected deep-bluelight and some visible light. The deep-blue light passes through thedeflecting element 712 out of the right and left optical paths. Thus,only the visible light and fluorescence light pass through the frontlens set 714, the zoom lens assembly 716, and the lens barrel set 718.In this example, the filter 740 is configured to apply thenear-ultraviolet cut filter to the optical paths to remove light outsidethe desired fluorescence spectrum including visible light and anyremaining NUV deep-blue light. Accordingly, only fluorescence light of anarrow wavelength reaches the optical image sensor 744, which enablesthe fluorescence light to be more easily detected and distinguishedbased on relative intensity.

In yet another mode, the filter 740 and the light sources 708 areconfigured to provide indocyanine green (“ICG”) fluorescence light tothe optical sensor 744. In this mode, the NIR light source 708 btransmits light in the far-red region (which is also considerednear-infrared) of the visible spectrum to the target site 700. Inaddition, the visible light source 708 a transmits visible light to thetarget scene 700. The visible light and far-red light are absorbed bymaterial with ICG at the target site, which then emits a highlystimulated fluorescence light in the further-red region. The mainobjective assembly 702 receives the fluorescence light in addition toreflected NIR light and visible light. The light is reflected by thedeflecting element 712 to the front lens set 714, the zoom lens assembly716, and the lens barrel set 718. In this example, the filter 740 isconfigured to apply the near-infrared bandpass filter to the opticalpaths to remove light outside the desired fluorescence spectrumincluding visible light and at least some of the NIR light. Accordingly,only fluorescence light in the further-red region reaches the opticalimage sensor 744, which enables the fluorescence light to be more easilydetected and distinguished based on relatively intensity.

TABLE 1 Light Transmitted to Light Source Filter Image Sensors VisibleInfrared Cut Filter, Visible Light Near-Ultraviolet Cut Filter NUVNear-Ultraviolet Cut Filter Blue Visible and NIR Light NIR andNear-Infrared Bandpass Filter Further-Red Fluorescence Visible

Table 1 above shows a summary of the different possible combinations oflights sources and filters for causing light of a certain desiredwavelength to reach the optical light sensor 744. It should beappreciated that other types of filters and/or light sources may be usedto further increase the different types of light received at the imagesensor 744. For instance, bandpass filters configured to pass light of anarrow wavelength may be used to correspond to certain biological stainsor contrasts applied to the target site 700. In some examples, thefilter 740 may include a cascade or more than one filter to enable lightfrom two different ranges to be filtered. For example, a first filter740 may apply an infrared cut filter and a near-ultraviolet cut filtersuch that only visible light of a desired wavelength range passes to theoptical sensor 744.

In other embodiments, separate filters 740 may be used for the left andright optical paths. For example, a right filter may include an infraredcut filter while a left filter includes a near-infrared pass filter.Such a configuration enables viewing of the target site 700 in visiblewavelengths simultaneously with IGC green fluorescence wavelengths. Inanother example, a right filter may include an infrared cut filter whilea left filter includes a near-ultraviolet cut filter. In thisconfiguration, the target site 700 may be shown in visible lightsimultaneously with SALA fluorescence light. In these other embodiments,the right and left image streams may still be combined into astereoscopic view that provides a fluorescence view of certainanatomical structures combined with a view of the target site 700 invisible light.

F. Example Final Optical Element Set

The example stereoscopic visualization camera 300 of FIGS. 7 and 8includes the final optical element set 742 to focus light received fromthe filter 740 onto the optical image sensor 744. The final opticalelement set 742 includes a right final optical element 745 and a leftfinal optical element 747, which may each comprise a positive converginglens. In addition to focusing light, the optical elements 745 and 747may be configured to correct minor aberrations in the right and leftoptical paths prior to the light reaching the optical image sensor 744.In some examples, the lenses 745 and 747 may be moveable radially and/oraxially to correct magnification and/or focusing aberrations caused bythe front lens set 714, the zoom lens assembly 716, and the lens barrelset 718. In an example, the left final optical element 747 may be movedradially while the right final optical element 745 is fixed to removeZRP movement during magnification changes.

G. Example Image Sensors

The example stereoscopic visualization camera 300 of FIGS. 7 and 8includes the image sensor 744 to acquire and/or record incident lightthat is received from the final optical element set 742. The imagesensor 744 includes a right optical image sensor 746 to acquire and/orrecord light propagating along the right optical path and a left opticalimage sensor 748 to acquire and/or record light propagating along theleft optical path. Each of the left and right optical image sensors 746and 748 include, for example, complementary metal-oxide-semiconductor(“CMOS”) sensing elements, N-type metal-oxide-semiconductor (“NMOS”),and/or semiconductor charge-coupled device (“CCD”) sensing elements. Insome embodiments, the left and right optical sensors 746 and 748 areidentical and/or have the same properties. In other embodiments, theleft and right optical sensors 746 and 748 include different sensingelements and/or properties to provide varying capability. For example,the right optical image sensor 746 (using a first color filter array)may be configured to be more sensitive to blue fluorescence light whilethe left optical image sensor 748 (using a second color filter array) isconfigured to be more sensitive to visible light.

FIG. 10 shows an example of the right optical image sensor 746 and theleft optical image sensor 748 of the image sensor 744, according to anexample embodiment of the present disclosure. The right optical imagesensor 746 includes a first two-dimensional grid or matrix 1002 oflight-sensing elements (e.g., pixels). In addition, the left opticalimage sensor 748 includes a second two-dimensional pixel grid 1004 oflight-sensing elements. Each of the pixels includes a filter thatenables only light of a certain wavelength to pass, thereby contactingan underlying light detector. Filters for different colors are spreadacross the sensors 746 and 748 to provide light detection for allwavelengths across grids. The light detector may be sensitive to visiblelight, as well as additional ranges that are above and below the visiblespectrum.

The light-sensing elements of the grids 1002 and 1004 are configured torecord a range of wavelengths of light as a representation of the targetsite 700 that is in the field-of-view. Light incident on a light-sensingelement causes an electrical change to accumulate. The electrical chargeis read to determine an amount of light being received at the sensingelement. In addition, since the filter characteristics of the sensingelement are known to within manufacturing tolerances, the range ofwavelengths of the received light is known. The representation of thetarget site 700 is directed onto the light-sensing elements such thatthe grids 1002 and 1004 for the respective optical image sensors 746 and748 sample the target site 700 spatially. The resolution of the spatialsampling is a parameter that affects image quality and parity.

The number of pixels shown in the pixel grids 1002 and 1004 in FIG. 10is not representative of the number of actual pixels in the opticalimage sensors 746 and 748. Instead, the sensors typically have aresolution between 1280×720 pixels and 8500×4500 pixels, preferablyaround 2048×1560 pixels. However, not all pixels of the grids 1002 and1004 are selected for image transmission. Instead, a subset or pixel setof the grids 1002 and 1004 are selected for transmission. For example,in FIG. 10, pixel set 1006 is selected from the pixel grid 1002 fortransmission as a right image and pixel set 1008 is selected from pixelgrid 1004 for transmission as a left image. As illustrated, the pixelset 1006 does not need to be located in the same location as the pixelset 1008 in relation to respective pixel grids 1002 and 1004. Theseparate control of the pixel sets 1006 and 1008 enables left and rightimages to be aligned and/or corrected for image defects and/or spuriousparallax such as moving ZRPs.

Selection of a pixel set from a pixel grid enables a portion of thepixel grid to be selected to compensate for image defects/spuriousparallax and/or to more align the right and left optical images. Inother words, the pixel set may be moved or adjusted (in real-time) withrespect to the pixel grid to improve image quality by reducing oreliminating spurious parallax. Alternatively, either or both of the leftand right views of the stereoscopic image can be moved virtually in theimage processing pipeline (for example during rendering of the views fordisplay) to accomplish the same effect. Rotational misalignment of thesensors can also be corrected virtually. A pixel set may also be movedacross a pixel grid during use to provide an appearance of panning thefield-of-view. In an example, a pixel set or window of 1920×1080 pixelsmay be selected from a pixel grid having 2048×1560 pixels. The locationof the pixel window or set may be controlled by software/firmware and bemoved during setup and/or use. The resolution of the optical imagesensors 746 and 748 is accordingly specified based on a number of pixelsin the length and width directions of the pixel set or window.

1. Color Sensing with the Example Image Sensors

As mentioned above, the optical sensing elements 746 and 748 includepixels with different filters to detect certain colors of light. Forinstance, some pixels are covered with filters that pass predominantlyred light, some are covered with filters that pass predominantly greenlight, and some are covered with filters that pass predominantly bluelight. In some embodiments, a Bayer pattern is applied to the pixelgrids 1002 and 1004. However, it should be appreciated that in otherembodiments, a different color pattern may be used that is optimized forcertain wavelengths of light. For example, a green filter in eachsensing region may be replaced with a broadband filter or anear-infrared filter, thereby extending the sensing spectrum.

The Bayer pattern is implemented by grouping two rows by two columns ofpixels and covering one with a red filter, one with a blue filter, andtwo with a green filter, each in a checkerboard pattern. Thus theresolution of red and blue are each one quarter of the whole sensingregion of interest while green resolution is half that of the wholesensing region of interest.

Green may be assigned to half the sensing region to cause the opticalimage sensors 746 and 748 to operate as a luminance sensor and mimic thehuman visual system. In addition, red and blue mimic chrominance sensorsof the human visual system, but are not as critical as green sensing.Once an amount of red, green, and blue are determined for a certainregion, other colors in the visible spectrum are determined by averagingthe red, green, and blue values, as discussed in conjunction withde-Bayer program 1580 a of FIG. 16 discussed below.

In some embodiments, the optical image sensors 746 and 748 may usestacked components to sense color rather than filters. For example,sensing elements may include red, green and blue sensing componentsstacked vertically inside a pixel's area. In another example, prismssplit incident light into components using specially coatedbeamsplitters one or more times (typically at least two times resultingin three component colors, known as “3-chip”) with sensing elementsplaced in each of the split beams' paths. Other sensor types use adifferent pattern such as replacing one of the green filters with abroadband filter or a near-infrared filter, thereby extending thesensing possibilities of the digital surgical microscope.

2. Sensing Light Outside the Visible Range with the Example ImageSensors

The example sensing element filters of the optical image sensors 746 and748 are configured to also pass near-infrared light in a range that thesensing element can detect. This enables the optical image sensors 746and 748 to detect at least some light outside of the visible range. Suchsensitivity may decrease image quality in the visible part of thespectrum because it “washes out” the image, reducing contrast in manytypes of scenes and negatively affecting the color quality. As a result,the filter 740 may use the infrared cut filter to block near infraredwavelengths while passing the visible wavelengths to the optical imagesensors 746 and 748.

However, such near-infrared sensitivity may be desirable. For example, afluorescent agent, such ICG, can be introduced to the target site 700.ICG becomes excited or activated with visible or other wavelengths orlight and emits fluorescence light in the near infrared range. Asmentioned above, the NIR light source 708 b provides NIR light and thevisible light source 708 a provides visible light to excite agents withICG. Emitted light is further along the red spectrum, which may bepassed through the filter 740 using a near-infrared bandpass orhigh-pass filter. The light from the red spectrum then is detected bythe optical image sensors 746 and 748. By matching the spectralcharacteristics of the filter 740 to the expected behaviors of the lightsource 708 and the fluorescent agent, the agent and the biologicalstructures, such as blood that contain the agent, can be differentiatedat the target site 700 from other structures that do not contain theagent.

Note that in this example, the NIR light source 708 b has a differentprimary wavelength from the near-infrared filter in the filter 740.Specifically, the NIR light source 708 b has a primary wavelength around780 nanometers (“nm”) (around which the majority of the light's outputspectrum exists). In contrast, the near-infrared filter of the filter740 transmits light at wavelengths in a range of approximately 810 nm to910 nm. The light from the NIR light source 708 b and light passedthrough the filter 740 are both “near-infrared” wavelengths. However,the light wavelengths are separated so that the example stereoscopicvisualization camera 300 can stimulate with the light source 708 anddetect with the optical image sensor 744 while filtering the stimulationlight. This configuration accordingly enables the use of fluorescentagents.

In another embodiment, agents can be excited in the blue, violet, andnear-ultraviolet region and fluoresce light in the red region. Anexample of such an agent includes porphyrin accumulation in malignantgliomas caused by the introduction of SALA. In this example, it isnecessary to filter out the blue light while passing the remainder ofthe spectrum. A near-ultraviolet cut filter is used for this situation.As in the case with “near-infrared” discussed above, the NUV lightsource 708 c has a different primary wavelength from thenear-ultraviolet cut filter in the filter 740.

H. Example Lens Carrier

Section IV(D) above mentions that at least some of the lenses of thefront lens set 714, the zoom lens assembly 716, and/or the lens barrelset 718 may move in one or more carriers along rails. For example, thefront zoom lens set 724 may comprise a carrier that moves front zoomlens 726 and 728 together axially.

FIGS. 11 and 12 show diagrams of example carriers, according to exampleembodiments of the present disclosure. In FIG. 11, carrier 724 includesthe right front zoom lens 726 and the left front zoom lens 728 within asupport structure 1102. The carrier 724 includes a rail holder 1104configured to moveably connect to rail 1106. A force ‘F’ is applied toan actuation section 1108 to cause the carrier 724 to move along therail 1106. The force ‘F’ may be applied by a leadscrew or other linearactuation device. As illustrated in FIG. 11, the force ‘F’ is applied atan offset of the carrier 724. Friction between the rail 1106 and thecarrier 724 generates a moment My that causes the support structure 1102to move slightly around the Y-axis shown in FIG. 11. This slightmovement may cause the right front zoom lens 726 and the left front zoomlens 728 to shift slightly in opposite directions causing spuriousparallax, which is an error in a parallax between views of astereoscopic image.

FIG. 12 shows another example of the carrier 724. In this example, force‘F’ is applied symmetrically at center structure 1202, which isconnected to the rail holder 1104 and the support structure 1102. Theforce ‘F’ generates a moment M_(x) that causes the carrier 724 to rotateor move slightly around the X-axis shown in FIG. 12. The rotationalmovement causes the right front zoom lens 726 and the left front zoomlens 728 to shift in the same direction by the same degree of movement,thereby reducing (or eliminating) the onset of spurious parallax.

While FIGS. 11 and 12 show lenses 726 and 728 within one carrier, inother embodiments the lenses 726 and 728 may each be within a carrier.In these examples, each lens would be on a separate track or rail.Separate leadscrews may be provided for each of the lenses to provideindependent axial movement along the respective optical path.

I. Example Flexure

Section IV(D) above mentions that at least some of the lenses of thefront lens set 714, the zoom lens assembly 716, and/or the lens barrelset 718 may be moved radially, rotated, and/or tilted. Additionally oralternatively, the optical image sensors 746 and 748 may be movedaxially and/or tilted with respect to their respective incident opticalpath. The axial and/or tilt movement may be provided by one or moreflexures. In some examples, the flexures may be cascaded such that afirst flexure provides motion in a first direction and separate flexureprovides independent motion in a second direction. In another example, afirst flexure provides tilt along a pitch axis and separate flexureprovides tilt along a yaw axis.

FIG. 13 shows a diagram of an example dual flexure 1300, according to anexample embodiment of the present disclosure. The flexure 1300illustrated in FIG. 13 is for the optical image sensor 744 and isconfigured to independently move the right optical image sensor 746 andthe left optical image sensor 748 along their respective optical axisfor purposes of final focusing. The flexure 1300 includes a support beam1301 for connection to the housing 302 of the example stereoscopicvisualization camera 300 and to provide a rigid base for actuation. Theflexure 1300 also includes a beam 1302 for each channel (e.g., sensor746 and 748) that is rigid in all directions except for the direction ofmotion 1310. The beam 1302 is connected to flexing hinges 1303 thatenable the beam 1302 to move in a direction of motion 1310, aparallelogram translation in this example.

An actuator device 1304 flexes the beam 1302 in the desired directionfor a desired distance. The actuator device 1304 includes a push-screw1306 and a pull screw 1308, for each channel, which apply oppositeforces to the beam 1302 causing the flexing hinges 1303 to move. Thebeam 1302 may be moved inward, for example, by turning the push-screw1306 to push on the beam 1302. The flexure 1300 illustrated in FIG. 13is configured to independently move the right optical image sensor 746and the left optical image sensor 748 axially along their optical axis.

After the beam 1302 is flexed into a desired position, a lockingmechanism is engaged to prevent further movement, thereby creating arigid column. The locking mechanism includes the push-screw 1306 and itsrespective concentric pull screw 1308, that when tightened, create largeopposing forces that result in the rigid column of the beam 1302.

While the optical image sensors 746 and 748 are shown as being connectedto the same flexure 1300, in other examples, the sensors may beconnected to separate flexures. For example, returning to FIG. 8, theright optical image sensor 746 is connected to flexure 750 and the leftoptical image sensor 748 is connected to flexure 752. The use of theseparate flexures 750 and 752 enables the optical image sensors 746 and748 to be separately adjusted to, for example, align the left and rightoptical views and/or reduce or eliminate spurious parallax.Alternatively, the flexures may be omitted.

In addition, while FIG. 13 shows image sensors 746 and 748 connected tothe flexure 1300, in other examples, the lenses of the front lens set714, the zoom lens assembly 716, the lens barrel set 718, and/or thefinal optical element set 742 may be connected to alternative oradditional flexures instead. In some instances, each of the right andleft lenses of the front lens set 714, the zoom lens assembly 716, thelens barrel set 718, and/or the final optical element set 742 may beconnected to a separate flexure 1300 to provide independent radial,rotational, and/or tilt adjustment.

The flexure 1300 may provide motion resolution of less than a micron. Asa result of the very fine motion adjustment, images from the right andleft optical paths may have an alignment accuracy of several or even onepixel for a 4K display monitor. Such accuracy is viewed on each display512, 514 by overlaying the left and right views and observing both viewswith both eyes, rather than stereoscopically.

In some embodiments, the flexure 1300 can include the flexure disclosedin U.S. Pat. No. 5,359,474, titled “SYSTEM FOR THE SUB-MICRONPOSITIONING OF A READ/WRITE TRANSDUCER,” the entirety of which isincorporated herein by reference. In yet other embodiments, the lensesof the front lens set 714, the zoom lens assembly 716, the lens barrelset 718, and/or the final optical element set 742 may be stationary in aradial direction. Instead, a deflecting element (e.g., a mirror) with anadjustable deflection direction in an optical path may be used to steerthe right and/or left optical paths to adjust alignment and/or spuriousparallax. Additionally or alternatively, a tilt/shift lens may beprovided in the optical path. For instance, a tilt of an optical axismay be controlled with an adjustable wedge lens. In further embodiments,lenses of the front lens set 714, the zoom lens assembly 716, the lensbarrel set 718, and/or the final optical element set 742 may includedynamic lenses with parameters that can be changed electronically. Forexample, the lenses may include Varioptic liquid lenses produced byInvenios France SAS.

V. Example Processors of the Stereoscopic Visualization Camera

The example stereoscopic visualization camera 300 is configured torecord image data from the right and left optical paths and output theimage data to the monitor(s) 512 and/or 514 for display as astereoscopic image. FIG. 14 shows a diagram of modules of the examplestereoscopic visualization camera 300 for acquiring and processing imagedata, according to an example embodiment of the present disclosure. Itshould be appreciated that the modules are illustrative of operations,methods, algorithms, routines, and/or steps performed by certainhardware, controllers, processors, drivers, and/or interfaces. In otherembodiments, the modules may be combined, further partitioned, and/orremoved. Further, one or more of the modules (or portions of a module)may be provided external to the stereoscopic visualization camera 300such as in a remote server, computer, and/or distributed computingenvironment.

In the illustrated embodiment of FIG. 14, the components 408, 702 to750, and 1300 in FIGS. 7 to 13 are collectively referred to as opticalelements 1402. The optical elements 1402 (specifically the optical imagesensors 746 and 748) are communicatively coupled to an image capturemodule 1404 and a motor and lighting module 1406. The image capturemodule 1404 is communicatively coupled to an information processormodule 1408, which may be communicatively coupled to an externallylocated user input device 1410 and one or more display monitors 512and/or 514.

The example image capture module 1404 is configured to receive imagedata from the optical image sensors 746 and 748. In addition, the imagecapture module 1404 may define the pixel sets 1006 and 1008 within therespective pixel grids 1002 and 1004. The image capture module 1404 mayalso specify image recording properties, such as frame rate and exposuretime.

The example motor and lighting module 1406 is configured to control oneor more motors (or actuators) to change a radial, axial, and/or tiltposition of one or more of the optical elements 1402. For instance, amotor or actuator may turn a drive screw to move the carrier 724 alongthe track 1106, as shown in FIGS. 11 and 12. A motor or actuator mayalso turn the push-screw 1306 and/or the pull screw 1308 of the flexure1300 of FIG. 13 to adjust a radial, axial, or tilt position of a lensand/or optical image sensor. The motor and lighting module 1406 may alsoinclude drivers for controlling the light sources 708.

The example information processor module 1408 is configured to processimage data for display. For instance, the information processor module1408 may provide color correction to image data, filter defects from theimage data, and/or render image data for stereoscopic display. Theinformation processor module 1408 may also perform one or morecalibration routines to calibrate the stereoscopic visualization camera300 by providing instructions to the image capture module 1404 and/orthe motor and lighting module 1406 to perform specified adjustments tothe optical elements. The information processor module 1408 may furtherdetermine and provide in real-time instructions to the image capturemodule 1404 and/or the motor and lighting module 1406 to improve imagealignment and/or reduce spurious parallax.

The example user input device 1410 may include a computer to provideinstructions for changing operation of the stereoscopic visualizationcamera 300. The user input device 1410 may also include controls forselecting parameters and/or features of the stereoscopic visualizationcamera 300. In an embodiment, the user input device 1410 includes thecontrol arms 304 of FIG. 3. The user input device 1410 may be hardwiredto the information processor module 1408. Additionally or alternatively,the user input device 1410 is wirelessly or optically communicativelycoupled to the information processor module 1408.

The example display monitors 512 and 514 include, for example,televisions and/or computer monitors configured to provide athree-dimensional viewing experience. For example, the display monitorsmay include the LG® 55LW5600 television. Alternatively, the displaymonitors 512 and 514 may include a laptop screen, tablet screen, asmartphone screen, smart-eyewear, a projector, a holographic display,etc.

The sections that follow describe the image capture module 1404, themotor and lighting module 1406, and the information processor module1408 in more detail.

A. Example Image Capture Module

FIG. 15 shows a diagram of the image capture module 1404, according toan example embodiment of the present disclosure. The example imagecapture module 1404 includes an image sensor controller 1502, whichincludes a processor 1504, a memory 1506, and a communications interface1508. The processor 1504, the memory 1506, and the communicationsinterface 1508 may be communicatively coupled together via an imagesensor controller bus 1512.

The processor 1504 is programmable with one or more programs 1510 thatare persistently stored within the memory 1506. The programs 1510include machine readable instructions, which when executed, cause theprocessor 1504 to perform one or more steps, routines, algorithms, etc.In some embodiments, the programs 1510 may be transmitted to the memory1506 from the information processor module 1408 and/or from the userinput device 1410. In other examples, the programs 1510 may betransmitted to the processor 1504 directly from the informationprocessor module 1408 and/or from the user input device 1410.

The example image sensor controller 1502 is communicatively coupled tothe right optical image sensor 746 and the left optical image sensor 748of the optical elements 1402. The image sensor controller 1502 isconfigured to provide power to the optical image sensors 746 and 748 inaddition to sending timing control data and/or programming data. Inaddition, the image sensor controller 1502 is configured to receiveimage and/or diagnostic data from the optical image sensors 746 and 748.

Each of the optical image sensors 746 and 748 contains programmableregisters to control certain parameters and/or characteristics. One ormore of the registers may specify a location of the pixel sets 1006 and1008 within the respective pixel grids 1002 and 1004 of FIG. 10. Theregisters may store a value of a starting location with respect to anorigin point or edge point of the pixel grids 1002 and 1004. Theregisters may also specify a width and height of the pixel sets 1006 and1008 to define a rectangular region of interest. The image sensorcontroller 1502 is configured to read pixel data for pixels that arewithin the specified pixel sets 1006 and 1008. In some embodiments, theregisters of the optical image sensors 746 and 748 may facilitate thedesignation of pixel sets of other shapes, such as circles, ovals,triangles, etc. Additionally or alternatively, the registers of theoptical image sensors 746 and 748 may enable multiple pixel sets to bespecified simultaneously for each of the pixel grids 1002 and 1004.

A light-sensing portion of the pixels of the pixel grids 1002 and 1004is controlled by embedded circuitry, which specifies different modes oflight-sensing. The modes include a reset mode, an integration mode, anda readout mode. During the reset mode, a charge storage component of apixel is reset to a known voltage level. During the integration mode,the pixel is switched to an “on” state. Light that reaches a sensingarea or element of the pixel causes a charge to accumulate in a chargestorage component (e.g., a capacitor). The amount of stored electricalcharge corresponds to the amount of light incident on the sensingelement during the integration mode. During the readout mode, the amountof electrical charge is converted into a digital value and read out ofthe optical image sensors 746 and 748 via the embedded circuitry andtransmitted to the image sensor controller 1502. To read every pixel,the charge storage component of each pixel in a given region isconnected sequentially by switched internal circuitry to a readoutcircuit, which performs the conversion of the electrical charge from ananalog value to digital data. In some embodiments, the pixel analog datais converted to 12-bit digital data. However, it should be appreciatedthat the resolution may be less or greater based on allowances fornoise, settling time, frame rate, and data transmission speed. Thedigital pixel data of each pixel may be stored to a register.

The example processor 1504 of the image sensor controller 1502 of FIG.15 is configured to receive pixel data (e.g., digital data indicative ofan electrical charge stored in the pixel corresponding to an amount ofincident light on an element of the pixel) from each of the pixelswithin the pixel sets 1006 and 1008. The processor 1504 forms a rightimage from the pixel data received from the right optical image sensor746. In addition, the processor 1504 forms a left image from the pixeldata received from the left optical image sensor 748. Alternatively, theprocessor 1504 forms only a portion (for example, one row or severalrows) of each the left and right images before transmitting the datadownstream. In some embodiments, the processor 1504 uses a registerlocation to determine a location of each pixel within an image.

After the right and left images are created, the processor 1504synchronizes the right and left images. The processor 1504 thentransmits both of the right and left images to the communicationsinterface 1508, which processes the images into a format fortransmission to the information processor module 1408 via acommunications channel 1514. In some embodiments, the communicationschannel 1514 conforms to the USB 2.0 or 3.0 standard and may comprise acopper or fiber optical cable. The communications channel 1514 mayenable up to approximately 60 pairs (or more) of left and right images(having a stereoscopic resolution of 1920×1080 and a data conversionresolution of 12-bits) per second to be transmitted per second. The useof a copper USB cable enables power to be provided from the informationprocessor module 1408 to the image capture module 1404.

The sections below further describe features provided by the processor1504 of the image sensor controller 1502 executing certain programs 1510to acquire and/or process image data from the optical image sensors 746and 748.

1. Exposure Example

The example processor 1504 may control or program an amount of time theoptical image sensors 746 and 748 are in the integration mode, discussedabove. The integration mode occurs for a time period referred to as anexposure time. The processor 1504 may set the exposure time by writing avalue to an exposure register of the optical image sensors 746 and 748.Additionally or alternatively, the processor 1504 may transmitinstructions to the optical image sensors 746 and 748 signaling thestart and end of the exposure time. The exposure time may beprogrammable between a few milliseconds (“ms”) to a few seconds.Preferably the exposure time is approximately the inverse of the framerate.

In some embodiments, the processor 1504 may apply a rolling shuttermethod to the optical image sensors 746 and 748 to read pixel data.Under this method, the exposure time for a given row of pixels of thepixel sets 1006 and 1008 begins just after the pixels in that row havebeen read out and then reset. A short time later, the next row (which istypically physically most proximate to the row just set) is read, andaccordingly reset with its exposure time restarted. The sequentialreading of each pixel row continues until the last or bottom row of thepixel sets 1006 and 1008 have been read and reset. The processor 1504then returns to the top row of the pixel sets 1006 and 1008 to readpixel data for the next image.

In another embodiment, the processor 1504 applies a global shuttermethod. Under this method, the processor 1504 implements readout andreset in a manner similar to the rolling shutter method. However, inthis method integration occurs simultaneously for all pixels in thepixel sets 1006 and 1008. The global shutter method has the advantage ofreducing defects in an image compared to the rolling shutter methodsince all of the pixels are exposed at the same time. In comparison, inthe rolling shutter method, there is a small time delay between exposingthe lines of the pixel set. Small defects can develop during the timesbetween line exposures, especially between top lines and bottom lineswhere small changes at the target site 700 between reads can occur.

2. Dynamic Range Example

The example processor 1504 may execute one or more programs 1510 todetect light that is outside of a dynamic range of the optical imagesensors 746 and 748. Generally, extremely bright light completely fillsa charge storage region of a pixel, thereby resulting in lost imageinformation regarding the exact brightness level. Similarly, extremelylow light or lack of light fails to impart a meaningful charge in apixel, which also results in lost image information. Images created fromthis pixel data accordingly do not accurately reflect the lightintensity at target site 700.

To detect light that is outside the dynamic range, the processor 1504may execute one of several high dynamic range (“HDR”) programs 1510including, for example, a multiple-exposure program, a multi-slope pixelintegration program, and a multi-sensor image fusion program. In anexample, the multiple-exposure program may utilize HDR featuresintegrated or embedded with the optical image sensors 746 and 748. Underthis method, the pixel sets 1006 and 1008 are placed into theintegration mode for a normal expose time. The lines of the pixel sets1006 and 1008 are read and stored in a memory at the optical imagesensors 746 and 748 and/or the memory 1506 of the image sensorcontroller 1502. After the read is performed by the processor 1504, eachline in the pixel sets 1006 and 1008 is turned on again for a secondexposure time that is less than the normal exposure time. The processor1504 reads each of the lines of pixels after the second exposure timeand combines this pixel data with the pixel data from the normalexposure time for the same lines. The processor 1504 may applytone-mapping to choose between (or combine) the pixel data from thenormal-length and short-length exposure times and map the resultingpixel data to a range that is compatible with downstream processing anddisplay. Using the multiple-exposure program, the processor 1504 is ableto expand the dynamic range of the optical image sensors 746 and 748 andcompress the resulting range of pixel data for display.

The processor 1510 may operate a similar program for relatively darklight. However, instead of the second exposure time being less than thenormal time, the second exposure time is greater than the normal time,thereby providing the pixels more time to accumulate a charge. Theprocessor 1510 may use tone-mapping to adjust the read pixel data tocompensate for the longer exposure time.

3. Frame Rate Example

The example processor 1510 may control or specify a frame rate for theoptical image sensors 746 and 748. In some embodiments, the opticalimage sensors 746 and 748 include on-board timing circuitry andprogrammable control registers to specify the number of times per secondeach of the pixels within the pixel sets 1006 and 1008 are to be cycledthrough the imaging modes discussed above. A frame or image is formedeach time the pixel set progresses through the three modes. A frame rateis the number of times per second the pixels in the pixel sets 1006 and1008 are integrated, read, and reset.

The processor 1510 may be synchronized with the optical image sensors746 and 748 such that reads are conducted at the appropriate time. Inother examples, the processor 1510 is asynchronous with the opticalimage sensors 746 and 748. In these other examples, the optical imagesensors 746 and 748 may store pixel data after a local read to atemporary memory or queue. The pixel data may then be read periodicallyby the processor 1510 for right and left image synchronization.

The processing of frames or images in a time-sequential manner (e.g.,creation of an image stream) provides an illusion of motion conveyed asa video. The example processor 1510 is configured to program a framerate that provides the appearance of a smooth video to an observer. Aframe rate that is too low makes any motion appear choppy or uneven.Movie quality above a maximum threshold frame rate is not discernable toan observer. The example processor 1510 is configured to generateapproximately 20 to 70 frames per second, preferably between 50 and 60frames per second for typical surgical visualization.

4. Sensor Synchronization Example

The example processor 1504 of FIG. 15 is configured to control thesynchronization of the optical image sensors 746 and 748. The processor1504 may, for instance, provide power simultaneously to the opticalimage sensors 746 and 748. The processor 1504 may then provide a clocksignal to both of the optical image sensors 746 and 748. The clocksignal enables the optical image sensors 746 and 748 to operateindependently in a free-run mode but in a synchronized and/orsimultaneous manner. Accordingly, the optical image sensors 746 and 748record pixel data at nearly the same time. The example processor 1504receives the pixel data from the optical image sensors 746 and 748,constructs at least a fraction of the images and/or frames andsynchronizes the images and/or frames (or fraction thereof) to accountfor any slight timing mismatches. Typically, the lag between the opticalimage sensors 746 and 748 is less than 200 microseconds. In otherembodiments, the processor 1504 may use a synchronization pin tosimultaneously activate the optical image sensors 746 and 748 after, forexample, each reset mode.

B. Example Motor and Lighting Module

The example stereoscopic visualization camera 300 of FIG. 15 includesthe motor and lighting module 1406 to control one or more motors oractuators for moving lenses of the optical elements 1402 and/orcontrolling lighting output from the light sources 708. The examplemotor and lighting module 1406 includes a motor and lighting controller1520 that contains a processor 1522, a memory 1524, and a communicationsinterface 1526 that are communicatively coupled together viacommunication bus 1528. The memory 1524 stores one or more programs 1530that are executable on the processor 1522 to perform control,adjustment, and/or calibration of the lenses of the optical elements1402 and/or the light sources 708. In some embodiments, the programs1530 may be transmitted to the memory 1524 from the informationprocessor module 1408 and/or the user input device 1410.

The communications interface 1526 is communicatively coupled to thecommunications interface 1508 of the image capture module 1404 and acommunications interface 1532 of the information processor module 1408.The communications interface 1526 is configured to receive commandmessages, timing signals, status messages, etc. from the image capturemodule 1404 and the information processor module 1408. For example, theprocessor 1504 of the image capture module 1404 may send timing signalsto the processor 1522 to synchronize timing between lighting control andexposure time of the optical image sensors 746 and 748. In anotherexample, the information processing module 1408 may send commandmessages instructing certain light sources 708 to be activated and/orcertain lenses of the optical elements 1402 to be moved. The commandsmay be in response to input received from an operator via, for example,the user input device 1410. Additionally or alternatively, the commandsmay be in response to a calibration routine and/or real-time adjustmentto reduce or eliminate image misalignment and/or defects such asspurious parallax.

The example motor and lighting module 1406 includes drivers that providepower to control motors for adjusting an axial and/or radial position ofthe lenses of the optical elements 1402 and/or the light output from thelight sources 708. Specifically, the motor and lighting module 1406includes a NUV light driver 1534 to transmit a NUV signal to the NUVlight source 708 c, a NIR light driver 1536 to transmit a NIR signal tothe NIR light source 708 b, and a visible light driver 1538 to transmita visible light signal to the visible light source 708 a.

In addition, the motor and lighting module 1406 includes a filter motordriver 1540 to transmit a filter motor signal to a filter motor 1542,which controls the filter 740 of FIGS. 7 and 8. The motor and lightingmodule 1406 includes a rear zoom lens motor driver 1544 to transmit arear zoom lens motor signal to a rear zoom lens motor 1546, a front zoomlens motor driver 1548 to transmit a front zoom lens motor signal to afront zoom lens motor 1550, and a rear working distance lens motordriver 1552 to transmit a working distance lens motor signal to aworking distance lens motor 1554. The motor and lighting module 1406 mayalso include a motor and/or actuator to move and/or tilt the deflectingelement 712.

The rear zoom lens motor 1546 is configured to rotate a drive screw thatcauses carrier 730 to move axially along a track or rail. The front zoomlens motor 1550 is configured to rotate a drive screw that causescarrier 724 to move axially along the track 1106 shown in FIGS. 11 and12. The working distance lens motor 1554 is configured to rotate a drivescrew that causes the rear working distance lens 702 to move axiallyalong a track or rail.

The drivers 1536, 1538, and 1540 may include any type of lightingdriver, transformer, and/or ballast. The drivers 1536, 1538, and 1540are configured to output a pulse width modulation (“PWM”) signal tocontrol an intensity of light output by the light sources 708. In someembodiments, the processor 1522 may control the timing of the drivers1536, 1538, and 1540 to correspond to a timing for applying a certainfilter using the filter motor driver 1540.

The example drivers 1540, 1544, 1548, and 1552 may include, for examplestepper motor drivers and/or DC motor drivers. Likewise, the motors1542, 1546, 1550, and/or 1554 may include a stepper motor, a DC motor,or other electrical, magnetic, thermal, hydraulic, or pneumaticactuator. The motors 1542, 1546, 1550, and/or 1554 may include, forexample, a rotary encoder, a slotted optical switch (e.g., aphotointerrupter), and/or a linear encoder to report an angular positionof a shaft and/or axle for feedback reporting and control. Alternativeembodiments may include voice-coil motors, piezoelectric motors, linearmotors, with suitable drivers, and equivalents thereof.

To control the drivers 1534, 1536, 1538, 1540, 1544, 1548, and 1552, theprocessor 1522 is configured to use a program 1530 for converting acommand message into a digital and/or analog signal. The processor 1522transmits the digital and/or analog signal to the appropriate driver,which outputs an analog power signal, such as a PWM signal correspondingto the received signal. The analog power signal provides power to anappropriate motor or actuator causing it to rotate (or otherwise move)by a desired amount.

The processor 1522 may receive feedback from the drivers 1534, 1536,1538, 1540, 1544, 1548, and 1552, the motors 1542, 1546, 1550, and/or1554, and/or the light sources 708. The feedback corresponds to, forexample, a lighting level or lighting output. Regarding the motors, thefeedback corresponds to a position of a motor (or other actuator) and/oran amount of movement. The processor 1522 uses a program 1530 totranslate the received signal into digital feedback to determine, forexample, a radial, tilt, and/or axial position of a lens based on anangular position of the corresponding motor or actuator shaft. Theprocessor 1522 may then transmit a message with the position informationto the information processor module 1408 for display to a user and/or totrack a position of the lenses of the optical elements 1402 forcalibration.

In some embodiments, the motor and lighting module 1406 may includeadditional drivers to change an axial, tilt, and/or radial position ofindividual lenses within the optical elements 1402. For example, themotor and lighting module 1406 may include drivers that control motorsfor actuating flexures 750 and 752 for the optical image sensors 746 and748 for tilting and/or radial/axial adjustment. Further, the motor andlighting module 1406 may include drivers that control motors (oractuators) for individually tilting and/or adjusting front lenses 720and 722, the front zoom lenses 726 and 728, the rear zoom lenses 732 and734, the lens barrels 736 and 738, and/or final optical elements 745 and747 radially along an x-axis or y-axis and/or axially. Independentadjustment of the lenses and/or sensors enables, for example, the motorand lighting controller 1520 to remove image defects and/or align theleft and right images.

The following sections describe how the processor 1552 executes one ormore programs 1530 to change a working distance, zoom, filter position,lens position, and/or light output.

1. Working Distance Example

The example processor 1522 of the motor and lighting module 1406 of FIG.15 is configured to adjust a working distance of the stereoscopicvisualization camera 300. The working distance is set by adjusting adistance between the rear working distance lens 704 and the frontworking distance lens 408. The processor 1522 adjusts the distance bycausing the rear working distance lens 704 to move relative to the frontworking distance lens 408. Specifically, the processor 1522 sends asignal to the rear working distance lens motor driver 1552, whichactivates the working distance lens motor 1554 for a predetermined timeproportional to an amount the rear working distance lens 704 is to bemoved. The working distance lens motor 1554 drives a leadscrew throughthreads attached to a sliding track that holds the rear working distancelens 704. The working distance lens motor 1554 causes the lens 704 tomove a desired distance, thereby adjusting the working distance. Theworking distance lens motor 1554 may provide a feedback signal to theprocessor 1522, which determines if the rear working distance lens 704was moved the desired amount. If the movement is less or more thandesired, the processor 1522 may send instructions further refining theposition of the rear working distance lens 704. In some embodiments, theinformation processor module 1408 may determine feedback control for therear working distance lens 704.

To determine a position of the rear working distance lens 704, theprocessor 1522 may operate one or more calibration programs 1530. Forexample, upon activation, the processor 1522 may instruct the workingdistance lens motor 1554 to drive a leadscrew to move the rear workingdistance lens 704 along a track or rail until triggering a limit switchat one end of the motion range. The processor 1522 may designate thisstop position as a zero-point for the encoder of the motor 1554. Havingknowledge of the current position of the rear working distance lens 704and the corresponding encoder value, the processor 1522 becomes capableof determining a number of shaft rotations to cause the rear workingdistance lens 704 to move to a desired position. The number of shaftrotations is transmitted in an analog signal to the working distancelens motor 1554 (via the driver 1552) to accordingly move the lens 704to a specified position.

2. Zoom Example

The example processor 1522 of FIG. 15 is configured to execute one ormore programs 1530 to change a zoom level of the stereoscopicvisualization camera 300. As discussed above, zoom (e.g., magnificationchange) is achieved by changing positions of the front zoom set 724 andthe rear zoom set 730 relative to each other and relative to the frontlens set 714 and the lens barrel set 718. Similar to the calibrationprocedure described above for the rear working distance lens 704, theprocessor 1522 may calibrate positions of the sets 724 and 730 alongtracks or rails. Specially, the processor 1522 sends instructionscausing the rear zoom lens motor 1546 and the front zoom lens motor 1550to move the sets 724 and 730 (e.g., carriers) along a rail (or rails) toa stop position at a limit switch. The processor 1522 receives encoderfeedback from the motors 1546 and 1550 to determine an encoder valueassociated with the stop position for the sets 724 and 730. Theprocessor 1522 may then zero-out the encoder value or use the knownencoder value at the stop position to determine how much the motors 1546and 1550 are to be activated to achieve a desired position for the sets724 and 730 along the rail.

In addition to calibration for stop position, the processor 1522 mayexecute programs 1530 that define locations for sets 724 and 730 toachieve a desired zoom level. For example, a known pattern of distancesettings versus a set of desired zoom values may be stored as a program1530 (or a look-up table) during a calibration procedure. Thecalibration procedure may include placing a template within the targetsite 700 and instructing the processor 522 to move the sets 724 and 730until a certain designated marker or character is a certain size inright and left images or frames. For example, a calibration routine maydetermine positions of the set 724 and 730 on a rail corresponding towhen character “E” on a template at the target site 700 is displayed inright and left images as having a height of 10 pixels.

In some embodiments, the information processor module 1408 may performthe visual analysis and send instructions to the processor 1522regarding desired movement for the sets 724 and 730 to zoom in or zoomout. In addition, the information processor 1408 may send instructionsfor moving the focal plane such that the target site 700 at the desiredzoom level is in focus. The instructions may include, for example,instructions to move the rear working distance lens 704 and/or movingthe sets 724 and 730 together and/or individually. In some alternativeembodiments, the processor 1522 may receive calibration parameters forthe rail position of the front zoom set 724 and the rear zoom set 730 atcertain zoom levels from the user input device 1410 or another computer.

The example processor 1522 and/or the information processor module 1408may send instructions such that an image remains in focus whilemagnification changes. The processor 1522, for example, may use aprogram 1530 and/or a look-up-table to determine how certain lenses areto be moved along an optical axis to retain focus on the target site700. The programs 1530 and/or look-up-table may specify magnificationlevels and/or set points on a rail and corresponding lens adjustmentsneeded to keep the focal plane from moving.

Table 2 below shows an example program 1530 or look-up-table that may beused by the processor 1522 to retain focus while changing magnification.The position of the front zoom lens set 724 and the rear zoom lens set730 is normalized based on a length of a rail to stop positions for therespective sets 724 and 730. To decrease magnification, the rear zoomlens set is moved toward the lens barrel set 718, thereby increasing aposition along a rail. The front zoom lens set 724 is also moved.However, its movement does not necessarily equal the movement of therear zoom lens set 730. Instead, the movement of the front zoom lens set724 accounts for changing a distance between the sets 724 and 730 toretain the position of the focal plane to maintain focus while changingmagnifications. For example, to decrease a magnification level from 10×to 9×, the processor 1522 instructs the rear zoom lens set 730 to movefrom position 10 to position 11 along a rail. In addition, the processor1522 instructs the front zoom lens set 724 to move from position 5 toposition 4 along a rail (or same rail as the set 730). Not only have thesets 724 and 730 moved to change magnification, the sets 724 and 730have moved relative to each other to retain focus.

TABLE 2 Front Zoom Lens Rear Zoom Lens Magnification Set Position SetPosition 10X  5 10 9X 4 11 8X 3 12 7X 4.5 14 6X 6 17 5X 8 20

It should be appreciated that Table 2 provides an example of how thesets 724 and 730 may be moved. In other examples, Table 2 may includeadditional rows to account for more precise magnifications and/orpositions of the sets 724 and 730. Additionally or alternatively, Table2 may include a column for the rear working distance lens 704. Forexample, the rear working distance lens 704 may be moved instead of orin conjunction with the front zoom lens set 724 to retain focus.Further, Table 2 may include rows specifying positions for the sets 724and 730 and the rear working distance lens 704 to retain focus duringchanges in working distance.

The values in Table 2 may be determined through calibration and/orreceived from a remote computer or the user input device 1410. Duringcalibration, the information processor module 1408 may operate acalibration program 1560 that progresses through differentmagnifications and/or working distances. A processor 1562 at theinformation processor module 1408 may perform image processing of theimages themselves or received pixel data to determine when a desiredmagnification is achieved using, for example, a template withpredetermined shapes and/or characters. The processor 1562 determines ifthe received images are in-focus. Responsive to determining images areout of focus, the processor 1562 sends instructions to the processor1522 to adjust the front zoom lens set 724 and/or the rear workingdistance lens set 704. The adjustment may include iterative movements inforward and reverse directions along an optical path until the processor1562 determines images are in focus. To determine an image is in focus,the processor 1562 may perform, for example, image analysis searchingfor images where light fuzziness is minimal and/or analyzing pixel datafor differences in light values between adjacent pixel regions (wheregreater differences correspond to more in focus images). Afterdetermining an image is in focus at a desired working distance andmagnification, the processor 1562 and/or the processor 1522 may thenrecord positions of the sets 724 and 730 and/or the rear workingdistance lens 704 and corresponding magnification level.

3. Filter Position Example

The example processor 1522 of the motor and lighting module 1406 of FIG.15 is configured to move the filter 740 into the right and left opticalpaths based on received instructions. In some examples, the filter 740may include a mirror array. In these examples, the processor 1522 sendsinstructions to the filter motor driver 1540 to actuate one or moremotors 1542 to change positions of the mirrors. In some instances, thedriver 1540 may send an electrical charge along one or more paths to thefilter 740, causing certain mirror elements to switch to an on or offposition. In these examples, the filter type selection is generallybinary based on which mirrors to actuate.

In other examples, the filter 740 may include a wheel, turret, or ringwith different types of filters such as an infrared cut filter,near-infrared bandpass filter, and near-ultraviolet cut filter. In theseexamples, the wheel is rotated by the filter motor 1542. The processor1522 determines stop positions of the wheel corresponding to partitionsbetween the different filters. The processor 1522 also determines rotaryencoder value corresponding to each of the stop positions.

The processor 1522 may operate a calibration program 1530 and/or theprocessor 1562 may operate a calibration program 1560 to determine thestop positions. For example, the processor 1522 may rotate the filter740 slowly, with the processor 1562 determining when light received atthe pixels changes (using either image analysis or reading pixel datafrom the image capture module 1404). A change in a light value at thepixels is indicative of a change in the filter type being applied to theoptical paths). In some instances, the processor 1522 may change whichlight sources 708 are activated to create further distinction at thepixels when a different filter type is applied.

4. Light Control and Filter Example

As disclosed above, the processor 1522 may control the light sources 708in conjunction with the filter 740 to cause light of a desiredwavelength to reach the optical image sensors 746 and 748. In someexamples, the processor 1522 may control or synchronize timing betweenactivation of one or more of the light sources 708 and one or more ofthe filters 740. To synchronize timing, a program 1530 may specify adelay time for activating a certain filter. The processor 1522 uses thisprogram 1530 to determine when, for example a signal to activate thefilter 740 is to be transmitted relative to sending a signal to turn ona light source 708. The scheduled timing ensures the appropriate filter740 is applied when the specified light source 708 is activated. Such aconfiguration enables features highlighted by one light source 708 (suchas fluorescence) to be shown on top of or in conjunction with featuresdisplayed under a second light source 708, such as white or ambientlight.

In some instances, the light sources 708 may be switched as fast as thelight filters 740 may be changed, thereby enabling images recorded indifferent lights to be shown in conjunction on top of each other. Forexample, veins or other anatomical structures that emit fluorescence(due to an administered dye or contrast agent) may be shown on top of animage under ambient lighting. In this example, the veins would behighlighted relative to the background anatomical features shown invisible light. In this instance, the processor 1562 and/or a graphicsprocessing unit 1564 (e.g., a video card or graphics card) of theinformation processor module 1408 combines or overlays one or moreimages recorded during application of one filter with images recordedduring application of a subsequent filter.

In some embodiments, the processor 1522 may activate multiple lightsources 708 at the same time. The light sources 708 can be activatedsimultaneously or sequentially to “interleave” light of differentwavelengths to enable different information to be extracted usingappropriate pixels at the optical image sensors 746 and 748. Activatingthe light sources simultaneously may help illuminate dark fields. Forexample, some applications use UV light to stimulate fluorescence at atarget site 700. However, UV light is perceived by an operator as beingvery dark. Accordingly, the processor 1522 may activate the visiblelight source 1538 periodically to add some visible light to the viewingfield so that the surgeon can observe the field-of-view withoutoverwhelming pixels that are sensitive to UV light but can also detectsome visible light. In another example, alternating between lightsources 708 avoids, in some instances, washing out pixels of the opticalimage sensors 746 and 748 that have overlapping sensitivity at the edgesof their ranges.

5. Light Intensity Control

The example processor 1522 of FIG. 15 is configured to execute one ormore programs 1530 to change an intensity of or a level of illuminationprovided by the light sources 708. It should be appreciated that thedepth of field is dependent on the level of illumination at the targetsite 700. Generally, higher illumination provides a greater depth offield. The processor 1522 is configured to ensure an appropriate amountof illumination is provided for a desired depth of field without washingout or overheating the field-of-view.

The visible light source 708 a is driven by the visible light driver1538 and outputs light in the human-visible part of the spectrum as wellas some light outside that region. The NIR light source 708 b is drivenby the NIR light driver 1536 and outputs light primarily at a wavelengththat referred to as near-infrared. The NUV light source 708 c is drivenby the NUV light driver 1534 and outputs light primarily at a wavelengththat is deep in the blue part of the visible spectrum, which is referredto as near-ultraviolet. The respective light drivers 1534, 1536, and1538 are controlled by commands provided by the processor 1522. Controlof the respective output spectra of the light sources 708 is achieved byPWM signal, where a control voltage or current is switched between aminimum (e.g., off) and maximum (e.g., on) value. The brightness of thelight that is output from the light sources 708 is controlled by varyingthe switching rate as well as the percentage of time the voltage orcurrent is at the maximum level per cycle in the PWM signal.

In some examples, the processor 1522 controls an output of the lightsources 708 based on a size of the field-of-view or zoom level. Theprocessor 1522 may execute a program 1530 that specifies for certainlight sensitive settings that light intensity becomes a function ofzoom. The program 1530 may include, for example a look-up-table thatcorrelates a zoom level to a light intensity value. The processor 1522uses the program 1530 to select the PWM signal for the light source 708based on the selected magnification level. In some examples, theprocessor 1522 may reduce light intensity as the magnification increasesto maintain the amount of light provided to the field-of-view per unitof area.

C. Example Information Processor Module

The example information processor module 1408 within the stereoscopicvisualization camera 300 of FIG. 15 is configured to analyze and processimages/frames received from the image capture module 1404 for display.In addition, the information processor module 1408 is configured tointerface with different devices and translate control instructions intomessages for the image capture module 1404 and/or the motor and lightingmodule 1406. The information processor module 1408 may also provide aninterface for manual calibration and/or manage automatic calibration ofthe optical elements 1402.

As shown in FIG. 15, the information processor module 1408 iscommunicatively and/or electrically coupled to the image capture module1404 and the motor and lighting module 1406. For example, thecommunications channel 1514 in addition to communications channels 1566and 1568 may include USB 2.0 or USB 3.0 connections. As such, theinformation processor module 1408 regulates and provides power to themodules 1404 and 1406. In some embodiments, the information processormodule 1408 converts 110-volt alternating current (“AC”) power from awall outlet into a 5, 10, 12, and/or 24 volt direct current (“DC”)supply for the modules 1404 and 1406. Additionally or alternatively, theinformation processor module 1408 receives electrical power from abattery internal to the housing 302 of the stereoscopic visualizationcamera 300 and/or a battery at the cart 510.

The example information processor module 1408 includes thecommunications interface 1532 to communicate bidirectionally with theimage capture module 1404 and the motor and lighting module 1406. Theinformation processor module 1408 also includes the processor 1562configured to execute one or more programs 1560 to process images/framesreceived from the image capture module 1404. The programs 1560 may bestored in a memory 1570. In addition the processor 1562 may performcalibration of the optical elements 1402 and/or adjust the opticalelements 1402 to align right and left images and/or remove visualdefects.

To process images and/or frames into a rendered three-dimensionalstereoscopic display, the example information processor module 1408includes the graphics processing unit 1564. FIG. 16 shows a diagram ofthe graphics processing unit 1564, according to an example embodiment ofthe present disclosure. During operation, the processor 1562 receivesimages and/or frames from the image capture module 1404. An unpackroutine 1602 converts or otherwise changes the images/frames from aformat conducive for transmission across the communications channel 1514into a format conducive for image processing. For instance, the imagesand/or frames may be transmitted across the communications channel 1514in multiple messages. The example unpack routine 1602 combines the datafrom the multiple messages to reassemble the frames/images. In someembodiments, the unpack routine 1602 may queue frames and/or imagesuntil requested by the graphics processing unit 1564. In other examples,the processor 1562 may transmit each right and left image/frame pairafter being completely received and unpacked.

The example graphics processing unit 1564 uses one or more programs 1580(shown in FIG. 15) to prepare images for rendering. Examples of theprograms 1580 are shown in FIGS. 15 and 16. The programs 1580 may beexecuted by a processor of the graphics processing unit 1564.Alternatively, each of the programs 1580 shown in FIG. 16 may beexecuted by a separate graphics processor, microcontroller, and/orapplication specific integrated circuit (“ASIC”). For example, ade-Bayer program 1580 a is configured to smooth or average pixel valuesacross neighboring pixels to compensate for a Bayer pattern applied tothe pixel grids 1002 and 1004 of the right and left optical imagesensors 746 and 748 of FIGS. 7 and 8. The graphics processing unit 1564may also include programs 1580 b, 1580 c, and 1580 d for colorcorrection and/or white balance adjustment. The graphics processing unit1564 also includes a renderer program 1580 e for preparing colorcorrected images/frames for display on the display monitors 512 and 514.The graphics processing unit 1564 may further interact and/or include aperipheral input unit interface 1574, which is configured to combine,fuse, or otherwise include other images and/or graphics for presentationwith the stereoscopic display of the target site 700. Further details ofthe programs 1580 and the information processor module 1408 moregenerally are discussed below.

The example information processor module 1408 may execute one or moreprograms 1562 to check for and improve latency of the stereoscopicvisualization camera 300. Latency refers to the amount of time taken foran event to occur at the target site 700 and for that same event to beshown by the display monitors 512 and 514. Low latency provides afeeling that the stereoscopic visualization camera 300 is an extensionof a surgeon's eyes while high latency tends to distract from themicrosurgical procedure. The example processor 1562 may track how muchtime elapses between images being read from the optical image sensors746 and 748 until the combined stereoscopic image based on the readimages is transmitted for display. Detections of high latency may causethe processor 1562 to reduce queue times, increase the frame rate,and/or skip some color correction steps.

1. User Input Example

The example processor 1562 of the information processor module 1408 ofFIG. 15 is configured to convert user input instructions into messagesfor the motor and lighting module 1406 and/or the image capture module1402. User input instructions may include requests to change opticalaspects of the stereoscopic visualization camera 300 including amagnification level, a working distance, a height of a focal plane(e.g., focus), a lighting source 708, and/or a filter type of the filter740. The user input instructions may also include requests to performcalibration, including indications of an image being in focus and/orindications of image alignment, and/or indications of aligned ZRPsbetween left and right images. The user input instructions may furtherinclude adjustments to parameters of the stereoscopic visualizationcamera 300, such as frame rate, exposure time, color correction, imageresolution, etc.

The user input instructions may be received from a user input device1410, which may include the controls 305 of the control arm 304 of FIG.3 and/or a remote control. The user input device 1410 may also include acomputer, tablet computer, etc. In some embodiments, the instructionsare received via a network interface 1572 and/or a peripheral input unitinterface 1574. In other embodiments, the instructions may be receivedfrom a wired connection and/or a RF interface.

The example processor 1562 includes programs 1560 for determining aninstruction type and determining how the user input is to be processed.In an example, a user may press a button of the control 305 to change amagnification level. The button may continue to be pressed until theoperator has caused the stereoscopic visualization camera 300 to reach adesired magnification level. In these examples, the user inputinstructions include information indicative that a magnification levelis to be, for example, increased. For each instruction received (or eachtime period in which a signal indicative of the instruction isreceived), the processor 1562 sends a control instruction to the motorand lighting processor 1406 indicative of the change in magnification.The processor 1522 determines from a program 1530 how much the zoom lenssets 724 and 730 are to be moved using, for example, Table 2. Theprocessor 1522 accordingly transmits a signal or message to the rearzoom lens motor driver 1544 and/or the front zoom lens motor driver 1548causing the rear zoom lens motor 1546 and/or the front zoom lens motor1550 to move the rear zoom lens set 730 and/or the front zoom lens set724 by an amount specified by the processor 1562 to achieve the desiredmagnification level.

It should be appreciated that in the above example, the stereoscopicvisualization camera 300 provides a change based on user input but alsomakes automatic adjustments to maintain focus and/or a high imagequality. For instance, instead of simply changing the magnificationlevel, the processor 1522 determines how the zoom lens sets 724 and 730are to be moved to also retain focus, thereby saving an operator fromhaving to perform this task manually. In addition, the processor 1562may, in real-time, adjust and/or align ZRPs within the right and leftimages as a magnification level changes. This may be done, for example,by selecting or changing locations of the pixel sets 1006 and 1008 withrespect to pixel grids 1002 and 1004 of FIG. 10.

In another example, the processor 1562 may receive an instruction fromthe user input device 1410 to change a frame rate. The processor 1562transmits a message to the processor 1504 of the image capture module1404. In turn, the processor 1504 writes to registers of the right andleft image sensors 746 and 748 indicative of the new frame rate. Theprocessor 1504 may also update internal registers with the new framerate to change a pace at which the pixels are read.

In yet another example, the processor 1562 may receive an instructionfrom the user input device 1410 to begin a calibration routine for ZRP.In response, the processor 1562 may execute a program 1560 thatspecifies how the calibration is to be operated. The program 1560 mayinclude, for example, a progression or iteration of magnification levelsand/or working distances in addition to a routine for verifying imagequality. The routine may specify that for each magnification level,focus is to be verified in addition to ZRP. The routine may also specifyhow the zoom lens sets 724 and 730 and/or the rear working distance lens704 are to be adjusted to achieve an in focus image. The routine mayfurther specify how ZRP of the right and left images are to be centeredfor the magnification level. The program 1560 may store (to alook-up-table) locations of zoom lens sets 724 and/or the 730 and/or therear working distance lens 704 in addition to locations of pixel sets1006 and 1008 and the corresponding magnification level once imagequality has been verified. Thus, when the same magnification level isrequested at a subsequent time, the processor 1562 uses thelook-up-table to specify positions for the zoom lens sets 724 and/or the730 and/or the rear working distance lens 704 to the motor and lightingmodule 1406 and positions for the pixel sets 1006 and 1008 to the imagecapture module 1404. It should be appreciated that in some calibrationroutines, at least some of the lenses of the optical elements 1402 maybe adjusted radially/rotationally and/or tilted to center ZRPs and/oralign right and left images.

2. Interface Example

To facilitate communications between the stereoscopic visualizationcamera 300 and external devices, the example information processormodule 1408 includes the network interface 1572 and the peripheral inputunit interface 1574. The example network interface 1572 is configured toenable remote devices to communicatively couple to the informationprocessor module 1408 to, for example, store recorded video, control aworking distance, zoom level, focus, calibration, or other features ofthe stereoscopic visualization camera 300. In some embodiments, theremote devices may provide values or parameters for calibrationlook-up-tables or more generally, programs 1530 with calibratedparameters. The network interface 1572 may include an Ethernetinterface, a local area network interface, and/or a Wi-Fi interface.

The example peripheral input unit interface 1574 is configured tocommunicatively couple to one or more peripheral devices 1576 andfacilitate the integration of stereoscopic image data with peripheraldata, such as patient physiological data. The peripheral input unitinterface 1574 may include a Bluetooth® interface, a USB interface, anHDMI interface, SDI, etc. In some embodiments, the peripheral input unitinterface 1574 may be combined with the network interface 1572.

The peripheral devices 1576 may include, for example, data or videostorage units, patient physiological sensors, medical imaging devices,infusion pumps, dialysis machines, and/or tablet computers, etc. Theperipheral data may include image data from a dedicated two-dimensionalinfrared-specialized camera, diagnostic images from a user's laptopcomputer, and/or images or patient diagnostic text from an ophthalmicdevice such as the Alcon Constellation® system and the WaveTec OptiwaveRefractive Analysis (ORA™) system.

The example peripheral input unit interface 1574 is configured toconvert and/or format data from the peripheral devices 1576 into anappropriate digital form for use with stereoscopic images. Once indigital form, the graphics processing unit 1564 integrates theperipheral data with other system data and/or the stereoscopicimages/frames. The data is rendered with the stereoscopic images fordisplay on the display monitors 512 and/or 514.

To configure the inclusion of peripheral data with the stereoscopicimages, the processor 1562 may control an integration setup. In anexample, the processor 1562 may cause the graphics processing unit 1564to display a configuration panel on the display monitors 512 and/or 514.The configuration panel may enable an operator to connect a peripheraldevice 1576 to the interface 1574 and the processor 1562 to subsequentlyestablish communications with the device 1576. The processor 1564 maythen read which data is available or enable the operator to use theconfiguration panel to select a data directory location. Peripheral datain the directory location is displayed in the configuration panel. Theconfiguration panel may also provide the operator an option to overlaythe peripheral data with stereoscopic image data or display as aseparate picture.

Selection of peripheral data (and overlay format) causes the processor1562 to read and transmit the data to the graphics processing unit 1564.The graphics processing unit 1564 applies the peripheral data to thestereoscopic image data for presentation as an overlay graphic (such asfusing a preoperative image or graphic with a real-time stereoscopicimage), a “picture-in-picture,” and/or a sub-window to the side or ontop of the main stereoscopic image window.

3. De-Bayer Program Example

The example de-Bayer program 1580 a of FIG. 16 is configured to produceimages and/or frames with values for red, green, and blue color at everypixel value. As discussed above, the pixels of the right and leftoptical image sensors 746 and 748 have a filter that passes light in thered wavelength range, the blue wavelength range, or the green wavelengthrange. Thus, each pixel only contains a portion of the light data.Accordingly, each image and/or frame received in the informationprocessor module 1408 from the image capture module 1404 has pixels thatcontain either red, blue, or green pixel data.

The example de-Bayer program 1580 a is configured to average the red,blue, and green pixel data of adjacent and/or neighboring pixels todetermine more complete color data for each pixel. In an example, apixel with red data and a pixel with blue data are located between twopixels with green data. The green pixel data for the two pixels isaveraged and assigned to the pixel with red data and the pixel with bluedata. In some instances, the averaged green data may be weighted basedon a distance of the pixel with red data and the pixel with blue datafrom the respective green pixels. After the calculation, the pixels withoriginally only red or blue data now include green data. Thus, after thede-Bayer program 1580 a is executed by the graphics processing unit1564, each pixel contains pixel data for an amount of red, blue, andgreen light. The pixel data for the different colors is blended todetermine a resulting color on the color spectrum, which may be used bythe renderer program 1580 e for display and/or the display monitors 512and 514. In some examples, the de-Bayer program 1580 a may determine theresulting color and store data or an identifier indicative of the color.

4. Color Correction Example

The example color correction programs 1580 b, 1580 c, and 1580 d areconfigured to adjust pixel color data. The sensor color correctionprogram 1580 b is configured to account or adjust for variability incolor sensing of the optical image sensors 746 and 748. The user colorcorrection program 1580 c is configured to adjust pixel color data basedon perceptions and feedback of an operator. Further, the display colorcorrection program 1580 d is configured to adjust pixel color data basedon a display monitor type.

To correct color for sensor variability, the example color correctionprogram 1580 b specifies a calibration routine that is executable by thegraphics processing unit 1564 and/or the processor 1562. The sensorcalibration includes placing a calibrated color chart, such as theColorChecker® Digital SG by X-Rite, Inc. at the target site 700. Theprocessor 1562 and/or the graphics processing unit 1564 executes theprogram 1580 b, which includes sending instructions to the image capturemodule 1404 to record right and left images of the color chart. Pixeldata from the right and left images (after being processed by thede-Bayer program 1580 a) may be compared to pixel data associated withthe color chart, which may be stored to the memory 1570 from aperipheral unit 1576 and/or a remote computer via the network interface1572. The processor 1562 and/or the graphics processing unit 1564determines differences between the pixel data. The differences arestored to the memory 1570 as calibration data or parameters. The sensorcolor correction program 1580 b applies the calibration parameters tosubsequent right and left images.

In some examples, the differences may be averaged over regions of pixelssuch that the program 1580 b finds a best-fit of color correction datathat can be applied globally to all of the pixels of the optical imagesensors 746 and 748 to produce colors as close to the color chart aspossible. Additionally or alternatively, the program 1580 b may processuser input instructions received from the user unit device 1410 tocorrect colors. The instructions may include regional and/or globalchanges to red, blue, and green pixel data based on operatorpreferences.

The example sensor color correction program 1580 b is also configured tocorrect for white balance. Generally, white light should result in red,green, and blue pixels having equal values. However, differences betweenpixels can result from color temperature of light used during imaging,inherent aspects of the filter and sensing element of each of thepixels, and spectral filtering parameters of, for example, thedeflecting element 712 of FIGS. 7 and 8. The example sensor colorcorrection program 1580 b is configured to specify a calibration routineto correct for the light imbalances.

To perform white balance, the processor 1562 (per instructions from theprogram 1580 b) may display an instruction on the display monitor 512and/or 514 for an operator to place a neutral card at the target site700. The processor 1562 may then instruct the image capture module 1404to record one or more images of the neutral card. After processing bythe unpack routine 1602 and the de-Bayer program 1580 a, the program1580 b determines regional and/or global white balance calibrationweight values for each of the red, blue, and green data such that eachof the pixels have substantially equal values of red, blue, and greendata. The white balance calibration weight values are stored to thememory 1570. During operation, the graphics processing unit 1564 usesthe program 1580 b to apply the white balance calibration parameters toprovide white balance.

In some examples, the program 1580 b determines white balancecalibration parameters individually for the right and left optical imagesensors 746 and 748. Of these examples, the program 1580 b may storeseparate calibration parameters for the left and right images. In otherinstances, the sensor color correction program 1580 b determines aweighting between the right and left views such that color pixel data isnearly identical for the right and left optical image sensors 746 and748. The determined weight may be applied to the white balancecalibration parameters for subsequent use during operation of thestereoscopic visualization camera 300.

In some embodiments, the sensor color correction program 1580 b of FIG.16 specifies that the white balance calibration parameters are to beapplied as a digital gain on the pixels of the right and left opticalimage sensors 746 and 748. For example, the processor 1504 of the imagecapture module 1404 applies the digital gain to pixel data read fromeach of the pixels. In other embodiments, the white balance calibrationparameters are to be applied as an analog gain for each pixel's colorsensing element.

The example sensor color correction program 1580 b may perform whitebalancing and/or color correction when the different light sources 708and/or filter types of the filter 740 are activated. As a result, thememory 1570 may store different calibration parameters based on whichlight source 708 is selected. Further, the sensor color correctionprogram 1580 b may perform white balancing and/or color correction fordifferent types of external light. An operator may use the user inputdevice 1410 to specify characteristics and/or a type of the externallight source. This calibration enables the stereoscopic visualizationcamera 300 to provide color correction and/or white balance fordifferent lighting environments.

The example program 1580 b is configured to perform calibration on eachof the optical image sensors 746 and 748 separately. Accordingly, theprogram 1580 b applies different calibration parameters to the right andleft images during operation. However, in some examples, calibration mayonly be performed on one sensor 746 or 748 with the calibrationparameters being used for the other sensor.

The example user color correction program 1580 c is configured torequest operator-provided feedback regarding image quality parameterssuch as brightness, contrast, gamma, hue, and/or saturation. Thefeedback may be received as instructions from the user input device1410. Adjustments made by the user are stored as user calibrationparameters in the memory 1570. These parameters are subsequently appliedby the user color correction program 1580 c to right and left opticalimages after color correction for the optical image sensors 746 and 748.

The example display color correction program 1580 d of FIG. 16 isconfigured to correct image color for a display monitor using, forexample, the Datacolor™ Spyder color checker. The program 1580 d,similar to the program 1580 b, instructs the image capture module 1404to record an image of a display color template at the target scene 700.The display color correction program 1580 d operates a routine to adjustpixel data to match an expected display output stored in a look-up-tablein the memory 1570. The adjusted pixel data may be stored as displaycalibration parameters to the memory 1570. In some examples, a camera orother imaging sensor may be connected to the peripheral input unitinterface 1574, which provides images or other feedback regarding colorrecorded from the display monitors 512 and 514, which is used to adjustthe pixel data.

5. Stereoscopic Image Display Example

The example renderer program 1580 e of the graphics processing unit 1564of FIG. 16 is configured to prepare right and left images and/or framesfor three-dimensional stereoscopic display. After the pixel data of theright and left images is color corrected by the programs 1580 b, 1580 c,and 1580 d, the renderer program 1580 e is configured to draw left-eyeand right-eye data into a format suitable for stereoscopic display andplace the final rendered version into an output buffer for transmissionto one of the display monitors 512 or 514.

Generally, the renderer program 1580 e receives a right image and/orframe and a left image and/or frame. The renderer program 1580 ecombines the right and left images and/or frames into a single frame. Insome embodiments, the program 1580 e operates a top-bottom mode andcondenses the left image data in height by half. The program 1580 e thenplaces the condensed left image data in a top half of the combinedframe. Similarly, the program 1580 e condenses the right image data inheight by half and places the condensed right image data in a bottomhalf of the combined frame.

In other embodiments, the renderer program 1580 e operates aside-by-side mode where each of the left and right images are condensedin width by half and combined in a single image such that the left imagedata is provided on a left half of the image while right image data isprovided on a right half of the image. In yet an alternative embodiment,the renderer program 1580 e operates a row-interleaved mode where everyother line in the left and right frames is discarded. The left and rightframes are combined together to form a complete stereoscopic image.

The example renderer program 1580 e is configured to render combinedleft and right images separately for each connected display monitor. Forinstance, if both the display monitors 512 and 514 are connected, therenderer program 1580 e renders a first combined stereoscopic image forthe display monitor 512 and a second combined stereoscopic image for thedisplay monitor 514. The renderer program 1580 e formats the first andsecond combined stereoscopic images such that they are compatible withthe type and/or screen size of the display monitors and/or screen.

In some embodiments, the renderer program 1580 e selects the imageprocessing mode based on how the display monitor is to displaystereoscopic data. Proper interpretation of stereoscopic image data bythe brain of an operator requires that the left eye data of thestereoscopic image be conveyed to the operator's left eye and the righteye data of the stereoscopic image be conveyed to the operator's righteye. Generally, display monitors provide a first polarization for lefteye data and a second opposing polarization for the right eye data.Thus, the combined stereoscopic image must match the polarization of thedisplay monitor.

FIG. 17 shows an example of the display monitor 512, according to anexample embodiment of the present disclosure. The display monitor 512may be, for example, the LG® 55LW5600 three-dimensional television witha screen 1702. The example display monitor 512 uses a polarization filmon the screen 1702 such that all odd rows 1704 have a first polarizationand all even rows 1706 have an opposing polarization. For compatibilitywith the display monitor 512 shown in FIG. 17, the renderer program 1580e would have to select the row-interleaved mode such that the left andright image data are on alternating lines. In some instances, therenderer program 1580 e may request (or otherwise receive) displaycharacteristics of the display monitor 512 prior to preparing thestereoscopic image.

To view the stereoscopic image displayed on the screen 1702, the surgeon504 (remember him from FIG. 5) wears glasses 1712 that include a leftlens 1714 that comprises a first polarization that matches the firstpolarization of the rows 1704. In addition, the glasses 1712 include aright lens 1716 that comprises a second polarization that matches thesecond polarization of the rows 1706. Thus, the left lens 1714 onlypermits a majority of the light from the left image data from the leftrows 1704 to pass through while blocking a majority of the light fromthe right image data. In addition, the right lens 1716 permits amajority of the light from the right image data from the right rows 1706to pass through while blocking a majority of the light from the leftimage data. The amount of light from the “wrong” view that reaches eachrespective eye is known as “crosstalk” and is generally held to a valuelow enough to permit comfortable viewing. Accordingly, the surgeon 504views left image data recorded by the left optical image sensor 748 in aleft eye while viewing right image data recorded by the right opticalimage sensor 746 in a right eye. The surgeon's brain fuses the two viewstogether to create a perception of three-dimensional distance and/ordepth. Further, the use of such a display monitor is advantageous forobserving the accuracy of the stereoscopic visualization camera 300. Ifthe surgeon or operator does not wear glasses, then both left and rightviews are observable with both eyes. If a planar target is placed at thefocal plane, the two images will be theoretically aligned. Ifmisalignment is detected, a re-calibration procedure can be initiated bythe processor 1562.

The example renderer program 1580 e is configured to render the left andright views for circular polarization. However, in other embodiments,the renderer program 1580 e may provide a stereoscopic image compatiblewith linear polarization. Regardless of which type of polarization isused, the example processor 1562 may execute a program 1560 to verify orcheck a polarity of the stereoscopic images being output by the rendererprogram 1580 e. To check polarity, the processor 1562 and/or theperipheral input unit interface 1574 inserts diagnostic data into theleft and/or right images. For example, the processor 1562 and/or theperipheral input unit interface 1574 may overlay “left” text onto theleft image and “right” text onto the right image. The processor 1562and/or the peripheral input unit interface 1574 may display a promptinstructing an operator to close one eye at a time while wearing theglasses 1712 to confirm the left view is being received at the left eyeand the right view is being received at the right eye. The operator mayprovide confirmation via the user input device 1410 indicating whetherthe polarization is correct. If the polarization is not correct, theexample renderer program 1580 e is configured to reverse locations wherethe left and right images are inserted into the combined stereoscopicimage.

In yet other embodiments, the example renderer program 1580 e isconfigured to provide for frame sequential projection instead ofcreating a combined stereoscopic image. Here, the renderer program 1580e renders the left images and or frames time-sequentially interleavedwith the right images and/or frames. Accordingly the left and rightimages are alternately presented to the surgeon 504. In these otherembodiments, the screen 1702 is not polarized. Instead, the left andright lenses of the glasses 1712 may be electronically or opticallysynchronized to their respective portion of a frame sequence, whichprovides corresponding left and right views to a user to discern depth.

In some examples, the renderer program 1580 e may provide certain of theright and left images for display on separate display monitors orseparate windows on one display monitor. Such a configuration may beespecially beneficial when lenses of right and left optical paths of theoptical elements 1402 are independently adjustable. In an example, aright optical path may be set a first magnification level while a leftoptical path is set at a second magnification level. The examplerenderer program 1580 e may accordingly display a stream of images fromthe left view on the display monitor 512 and a stream of images from theright view on the display monitor 514. In some instances, the left viewmay be displayed in a first window on the display monitor 512 while theright view is displayed in a second window (e.g., a picture-in-picture)of the same display monitor 512. Thus, while not stereoscopic, theconcurrent display of the left and right images provides usefulinformation to a surgeon.

In another example, the light sources 708 and the filter 740 may beswitched quickly to generate alternating images with visible light andfluorescent light. The example renderer program 1580 e may combine theleft and right views to provide a stereoscopic display under differentlighting sources to highlight, for example, a vein with a dye agentwhile showing the background in visible light.

In yet another example, a digital zoom may be applied to the rightand/or left optical image sensor 746 or 748. Digital zoom generallyaffects the perceived resolution of the image and is dependent onfactors such as the display resolution and the preference of the viewer.For example, the processor 1504 of the image capture module 1404 mayapply digital zooming by creating interpolated pixels synthesized andinterspersed between the digitally-zoomed pixels. The processor 1504 mayoperate a program 1510 that coordinates the selection and interpolationpixels for the optical image sensors 746 and 748. The processor 1504transmits the right and left images with digital zoom applied to theinformation processor module 1408 for subsequent rendering and display.

In some embodiments, the processor 1504 receives instructions from theprocessor 1562 that a digital zoom image is to be recorded betweenimages without digital zoom to provide a picture-in-picture (or separatewindow) display of a digital zoom of a region of interest of the targetsite 700. The processor 1504 accordingly applies digital zooming toevery other read from the pixel grids 1002 and 1004. This enables therenderer program 1580 e to display simultaneously a stereoscopic fullresolution image in addition to a digitally-zoomed stereoscopic image.Alternatively, the image to be zoomed digitally is copied from thecurrent image, scaled, and placed during the render phase in the properposition overlaid atop the current image. This alternativelyconfiguration avoids the “alternating” recording requirement.

6. Calibration Example

The example information processor module 1408 of FIGS. 14 to 16 may beconfigured to execute one or more calibration programs 1560 tocalibrate, for example, a working distance and/or magnification. Forexample, the processor 1562 may send instructions to the motor andlighting module 1406 to perform a calibration step for mapping a workingdistance (measured in millimeters) from the main objective assembly 702to the target site 700 to a known motor position of the working distancelens motor 1554. The processor 1562 performs the calibration bysequentially moving an object plane in discrete steps along the opticalaxis and re-focusing the left and right images, while recording encodercounts and the working distance. In some examples, the working distancemay be measured by an external device, which transmits the measuredworking distance values to the processor 1562 via the peripheral inputunit interface 1574 and/or an interface to the user input device 1410.The processor 1562 may store the position of the rear working distancelens 704 (based on position of the working distance lens motor 1554) andthe corresponding working distance.

The example processor 1562 may also execute a program 1560 to performmagnification calibration. The processor 1562 may set the opticalelements 1402, using the motor and lighting module 1406 to selectmagnification levels. The processor 1562 may record positions of theoptical elements 1402, or corresponding motor positions with respect toeach magnification level. The magnification level may be determined bymeasuring a height in an image of an object of a known size. Forexample, the processor 1562 may measure an object as having a height of10 pixels and use a look-up-table to determine that a 10 pixel heightcorresponds to a 5× magnification.

To match the stereoscopic perspectives of two different imagingmodalities it is often desirable to model them both as if they aresimple pinhole cameras. The perspective of a 3D computer model, such asa MM brain tumor, can be viewed from user-adjustable directions anddistances (e.g. as if the images are recorded by a synthesizedstereoscopic camera). The adjustability can be used to match theperspective of the live surgical image, which must therefore be known.The example processor 1562 may calibrate one or more of these pinholecamera parameters such as, for example, a center of projection (“COP”)of the right and left optical image sensors 746 and 748. To determinecenter of projection, the processor 1562 determines a focus distancefrom the center of projection to an object plane. First, the processor1562 sets the optical elements 1402 at a magnification level. Theprocessor 1562 then records measurements of a height of an image atthree different distances along the optical axis including at the objectplane, a distance d less than the object plane distance, and a distanced greater than the object plane distance. The processor 1562 uses analgebraic formula for similar triangles at the two most extremepositions to determine the focus distance to the center of projection.The processor 1562 may determine focus distances at other magnificationsusing the same method or by determining a ratio between themagnifications used for calibration. The processor may use a center ofprojection to match the perspective of an image of a desired fusionobject, such as an MM tumor model, to a live stereoscopic surgicalimage. Additionally or alternatively, existing camera calibrationprocedures such as OpenCV calibrateCamera may be used to find theabove-described parameters as well as additional camera information suchas a distortion model for the optical elements 1402.

The example processor 1562 may further calibrate the left and rightoptical axes. The processor 1562 determines an interpupillary distancebetween the left and right optical axes for calibration. To determinethe interpupillary distance, the example processor 1562 records left andright images where pixel sets 1006 and 1008 are centered at the pixelgrids 1002 and 1004. The processor 1562 determines locations of ZRPs(and/or distances to a displaced object) for the left and right images,which are indicative of image misalignment and degree of parallax. Inaddition, the processor 1562 scales the parallax and/or the distancebased on the magnification level. The processor 1562 then determines theinterpupillary distance using a triangulation calculation taking intoaccount the degree of parallax and/or the scaled distance to the objectin the display. The processor 1562 next associates the interpupillarydistance with the optical axis at the specified magnification level as acalibration point.

VI. Image Alignment and Spurious Parallax Adjustment Embodiment

Similar to human vision, stereoscopic images comprise right views andleft views that converge at a point of interest. The right and leftviews are recorded at slightly different angles from the point ofinterest, which results in parallax between the two views. Items in thescene in front of or behind the point of interest exhibit parallax suchthat distance or depth of the items from the viewer can be deduced. Theaccuracy of the perceived distance is dependent on, for example, theclarity of the viewer's eyesight. Most humans exhibit some level ofimperfection in their eyesight, resulting in some inaccuracies betweenthe right and left views. However, they are still able to achievestereopsis, with the brain fusing the views with some level of accuracy.

When left and right images are recorded by a camera instead of beingviewed by a human, the parallax between the combined images on a displayscreen produces stereopsis, which provides an appearance of athree-dimensional stereoscopic image on a two-dimensional display.Errors in the parallax can affect the quality of the three-dimensionalstereoscopic image. The inaccuracy of the observed parallax incomparison to a theoretically perfect parallax is known as spuriousparallax. Unlike humans, cameras do not have brains that automaticallycompensate for the inaccuracies.

If spurious parallax becomes significant, the three-dimensionalstereoscopic image may be unviewable to the point of inducing vertigo,headaches, and nausea. There are many factors that can affect theparallax in a microscope and/or camera. For instance, optical channelsof the right and left views may not be exactly equal. The opticalchannels may have unmatched focus, magnification, and/or misalignment ofpoints of interest. These issues may have varying severity at differentmagnifications and/or working distances, thereby reducing efforts tocorrect through calibration.

Known surgical microscopes, such as the surgical microscope 200 of FIG.2 are configured to provide an adequate view through the oculars 206.Often, the image quality of optical elements of known surgicalmicroscopes is not sufficient for stereoscopic cameras. The reason forthis is because manufacturers of surgical microscopes assume the primaryviewing is through oculars. Any camera attachment (such as the camera212) is either monoscopic and not subject to spurious parallax orstereoscopic with low image resolution where spurious parallax is not asapparent.

International standards, such as ISO 10936-1:2000, Optics and opticalinstruments—Operation microscopes—Part 1: Requirements and test methods,have been developed to provide specification limits for image quality ofsurgical microscopes. The specification limits are generally set forviewing through the oculars of a surgical microscope and do not considerthree-dimensional stereoscopic display. For example, regarding spuriousparallax, ISO 10936-1:2000 specifies that the difference in verticalaxes between the left and right views should be less than 15arc-minutes. Small angular deviations of axes are often quantified inarc-minutes, which corresponds to 1/60 of a degree, or arc-seconds,which corresponds to 1/60 of an arc-minute. The 15 arc-minutespecification limit corresponds to a 3% difference between left andright views for a typical surgical microscope with a working distance of250 mm and a field-of-view of 35 mm (which has an angular field-of-viewof 8°).

The 3% difference is acceptable for ocular viewing where a surgeon'sbrain is able to overcome the small degree of error. However, this 3%difference produces noticeable differences between left and right viewswhen viewed stereoscopically on a display monitor. For example, when theleft and right views are shown together, a 3% difference results in animage that appears disjointed and difficult to view for extended periodsof time.

Another issue is that known surgical microscopes may satisfy the 15arc-minute specification limit at only one or a few magnification levelsand/or only individual optical elements may satisfy a certainspecification limit. For example, individual lenses are manufactured tomeet certain criteria. However, when the individual optical elements arecombined in an optical path, small deviations from the standard may beamplified rather than cancelled. This can be especially pronounced whenfive or more optical elements are used in an optical path including acommon main objective lens. In addition, it is very difficult toperfectly match optical elements on parallel channels. At most, duringmanufacture, the optical elements of a surgical microscope arecalibrated only at one or a few certain magnification levels to meet the15 arc-minute specification limit. Accordingly, the error may be greaterbetween the calibration points despite the surgical microscope allegedlymeeting the ISO 10936-1:2000 specifications.

In addition, the ISO 10936-1:2000 specification permits largertolerances when additional components are added. For example, addingsecond oculars (e.g., the oculars 208) increases the spurious parallaxby 2 arc-minutes. Again, while this error may be acceptable for viewingthrough oculars 206 and 208, image misalignment becomes more pronouncedwhen viewed stereoscopically through the camera.

In comparison to known surgical microscopes, the example stereoscopicvisualization camera 300 disclosed herein is configured to automaticallyadjust at least some of the optical elements 1402 to reduce or eliminatespurious parallax. Embedding the optical elements within thestereoscopic visualization camera 300 enables fine adjustments to bemade automatically (sometimes in real-time) for three-dimensionalstereoscopic display. In some embodiments, the example stereoscopicvisualization camera 300 may provide an accuracy of 20 to 40arc-seconds, which is close to a 97% reduction in optical error comparedto the 15 arc-minute accuracy of known surgical microscopes.

The improvement in accuracy enables the example stereoscopicvisualization camera 300 to provide features that are not capable ofbeing performed with known stereoscopic microscopes. For example, manynew microsurgical procedures rely on accurate measurements in a livesurgical site for optimal sizing, positioning, matching, directing, anddiagnosing. This includes determining a size of a vessel, an angle ofplacement of a toric Intra Ocular Lens (“IOL”), a matching ofvasculature from a pre-operative image to a live view, a depth of atumor below an artery, etc. The example stereoscopic visualizationcamera 300 accordingly enables precise measurements to be made using,for example, graphical overlays or image analysis to determine sizes ofanatomical structures.

Known surgical microscopes require that a surgeon place an object of aknown size (such as a micro-ruler) into the field-of-view. The surgeoncompares the size of the object to surrounding anatomical structure todetermine an approximate size. However, this procedure is relativelyslow since the surgeon has to place the object in the proper location,and then remove it after the measurement is performed. In addition, themeasurement only provides an approximation since the size is based onthe surgeon's subjective comparison and measurement. Some knownstereoscopic cameras provide graphical overlays to determine size.However, the accuracy of these overlays is reduced if spurious parallaxexists between the left and right views.

A. ZRP as a Source of Spurious Parallax

ZRP inaccuracy provides a significant source of error between left andright images resulting in spurious parallax. ZRP, or zoom repeat point,refers to a point in a field-of-view that remains in a same location asa magnification level is changed. FIGS. 18 and 19 show examples of ZRPin a left and right field-of-view for different magnification levels.Specifically, FIG. 18 shows a left field-of-view 1800 for a lowmagnification level and a left field-of-view 1850 for a highmagnification level. In addition, FIG. 19 shows a right field-of-view1900 for a low magnification level and a right field-of-view 1950 for ahigh magnification level.

It should be noted that FIGS. 18 and 19 show crosshairs 1802 and 1902 toprovide an exemplary point of reference for this disclosure. Thecrosshairs 1802 include a first crosshair 1802 a positioned along ay-direction or y-axis and a second crosshair 1802 b positioned along anx-direction or x-axis. Additionally, crosshairs 1902 include a firstcrosshair 1902 a positioned along a y-direction or y-axis and a secondcrosshair 1902 b positioned along an x-direction or x-axis. In actualimplementation, the example stereoscopic visualization camera 300 bydefault typically does not include or add crosshairs to the optical pathunless requested by an operator.

Ideally, the ZRP should be positioned at a central location or originpoint. For example, the ZRP should be centered in the crosshairs 1802and 1902. However, inaccuracies in the optical elements 1402 and/orslight misalignments between the optical elements 1402 cause the ZRP tobe located away from the center of the crosshairs 1802 and 1902. Thedegree of spurious parallax corresponds to how far each of the ZRPs ofthe left and right views is located away from the respective centers inaddition to ZRPs being misaligned between the left and right views.Moreover, inaccuracies in the optical elements 1402 may cause the ZRP todrift slightly as magnification changes, thereby further causing agreater degree of spurious parallax.

FIG. 18 shows three crescent-shaped objects 1804, 1806, and 1808 in thefield-of-views 1800 and 1850 of the target site 700 of FIG. 7. It shouldbe appreciated that the field-of-views 1800 and 1850 are linearfield-of-views with respect to the optical image sensors 746 and 748.The objects 1804, 1806, and 1808 were placed in the field-of-view 1800to illustrate how spurious parallax is generated from left and rightimage misalignment. The object 1804 is positioned above crosshair 1802 balong crosshair 1802 a. The object 1806 is positioned along crosshair1802 b and to the left of the crosshair 1802 a. The object 1808 ispositioned slightly below the crosshair 1802 b and to the right of thecrosshair 1802 a. A ZRP 1810 for the left field-of-view 1800 ispositioned in a notch of the object 1808.

The left field-of-view 1800 is changed to the left field-of-view 1850 byincreasing the magnification level (e.g., zooming) using the zoom lensassembly 716 of the example stereoscopic visualization camera 300.Increasing the magnification causes the objects 1804, 1806, and 1808 toappear to expand or grow, as shown in the field-of-view 1850. In theillustrated example, the field-of-view 1850 is approximately 3× themagnification level of the field-of-view 1800.

Compared to the low magnification field-of-view 1800, the objects 1804,1806, and 1808 in high magnification field-of-view 1850 have increasedin size by about 3× while also moving apart from each other by 3X withrespect to the ZRP 1810. In addition, the positions of the objects 1804,1806, and 1808 have moved relative to the crosshairs 1802. The object1804 is now shifted to the left of the crosshair 1802 a and shiftedslightly further from the crosshair 1802 b. In addition, the object 1806is now shifted further to the left of crosshair 1802 a and slightlyabove the crosshair 1802 b. Generally, the object 1808 is located in thesame (or nearly the same) position with respect to the crosshairs 1802,with the ZRP 1810 being located in the exact same (or nearly the same)position with respect to the crosshairs 1802 and the object 1806. Inother words, as magnification increases, the objects 1804, 1806, and1808 (and anything else in the field-of-view 1850) appear to move awayand outward from the ZRP 1810.

The same objects 1804, 1806, and 1808 are shown in the rightfield-of-views 1900 and 1950 illustrated in FIG. 19. However, thelocation of the ZRP is different. Specifically, Z R P 1910 is locatedabove crosshair 1902 b and to the left of crosshair 1902 a in the rightfield-of-views 1900 and 1950. Thus, the ZRP 1910 is located at adifferent location than the ZRP 1810 in the left field-of-views 1800 and1850. In the illustrated example, it is assumed that the left and rightoptical paths are perfectly aligned at the first magnification level.Accordingly, the objects 1804, 1806, and 1808 shown in the rightfield-of-view 1900 in the same location as the same objects 1804, 1806,and 1808 in the left field-of-view 1800. Since the left and right viewsare aligned, no spurious parallax exists.

However, in the high magnification field-of-view 1950, the objects 1804,1806, and 1808 expand and move away from the ZRP 1910. Given thelocation of the ZRP 1910, the object 1804 moves or shifts to the rightand the object 1806 moves or shifts downward. In addition, the object1808 moves downward and to the right compared to its location in thefield-of-view 1900.

FIG. 20 shows a pixel diagram comparing the high magnification leftfield-of-view 1850 to the high magnification right field-of-view. A grid2000 may represent locations of the objects 1804(L), 1806(L), and1808(L) on the pixel grid 1004 of the left optical image sensor 748overlaid with locations of the objects 1804(R), 1806(R), and 1808(R) onthe pixel grid 1002 of the left optical image sensor 746. FIG. 20clearly shows that the objects 1804, 1806, and 1808 are in differentpositions for the left and right field-of-views 1850 and 1950. Forexample, the object 1804(R) is located to the right of crosshair 1902 aand above crosshair 1902 b while the same object 1804(L) is located tothe left of cross hair 1802 a and further above cross hair 1802 b.

The difference in positions of the objects 1804, 1806, and 1808corresponds to spurious parallax, which is created by deficiencies inthe optical alignment of the optical elements 1402 that produce ZRPs1810 and 1910 in different locations. Assuming no distortion or otherimaging errors, the spurious parallax shown in FIG. 20 is generally thesame for all points within the image. When viewed through oculars of asurgical microscope (such as microscope 200 of FIG. 2), the differencein location of the objects 1804, 1806, and 1808 may not be noticeable.However, when viewed on the display monitors 512 and 514 in astereoscopic image, the differences become readily apparent and canresult in headaches, nausea, and/or vertigo.

FIG. 21 shows a diagram illustrative of spurious parallax with respectto left and right ZRPs. The diagram includes a pixel grid 2100 thatincludes overlays of the right and left pixel grids 1002 and 1004 ofFIG. 10. In this illustrated example, a left ZRP 2102 for the leftoptical path is located at +4 along the x-axis and 0 along the y-axis.In addition, a right ZRP 2104 for the right optical path is located at−1 along the x-axis and 0 along the y-axis. An origin 2106 is shown atthe intersection of the x-axis and the y-axis.

In this example, object 2108 is aligned with respect to the left andright images at a first low magnification. As magnification is increasedby 3×, the object 2108 increased in size and moved away from the ZRPs2102 and 2104. Outlines object 2110 shows a theoretical location of theobject 2108 at the second higher magnification based on the ZRPs 2102and 2104 being aligned with the origin 2106. Specifically, a notch ofthe object 2108 at the first magnification level is at location +2 alongthe x-axis. With 3× magnification, the notch moves 3X along the x-axissuch that the notch is located at +6 along the x-axis at the highermagnification level. In addition, since the ZRPs 2102 and 2104 would betheoretically aligned at the origin 2106, the object 2110 would bealigned between the left and right views (shown in FIG. 21 as a singleobject given the overlay).

However, in this example, misalignment of the left and right ZRPs 2102and 2104 causes the object 2110 to be misaligned between the left andright views at higher magnification. Regarding the right optical path,the right ZRP 2104 is located at −1 along the x-axis such that it is 3pixels away from the notch of the object 2108 at low magnification. Whenmagnified 3×, this difference becomes 9 pixels, which is shown as object2110(R). Similarly, the left ZRP 2102 is located at +4 pixels along thex-axis. At 3× magnification, the object 2108 moves from being 2 pixelsaway to 6 pixels away, which is shown as object 2110(L) at −2 along thex-axis.

The difference in positions of the object 2110(L) and the object 2110(R)corresponds to the spurious parallax between the left and right views atthe higher magnification. If the right and left views were combined intoa stereoscopic image for display, the location of the object 2110 wouldbe misaligned at each row if the renderer program 1850 e uses arow-interleaved mode. The misalignment would be detrimental togenerating stereopsis and may produce an image that appears blurred orconfusing to an operator.

B. Other Sources of Spurious Parallax

While ZRP misalignment between left and right optical paths is asignificant source of spurious parallax, other sources of error alsoexist. For example, spurious parallax may result from non-equalmagnification changes between the right and left optical paths.Differences in magnification between parallel optical paths may resultfrom slight variances in the optical properties or characteristics ofthe lenses of the optical elements 1402. Further, slight differences mayresult from positioning if each of the left and right front zoom lenses726 and 728 and each of the left and right rear zoom lenses 736 and 738of FIGS. 7 and 8 are independently controlled.

Referring back to FIGS. 18 and 19, differences in magnification changeproduce differently sized objects and different spacing between theobjects for the left and right optical paths. If, for example, the leftoptical path has a higher magnification change, then the objects 1804,1806, and 1808 will appear larger and move a greater distance from theZRP 1810 compared to the objects 1804, 1806, and 1808 in the rightfield-of-view 1950 in FIG. 19. The difference in the location of theobjects 1804, 1806, and 1808, even if the ZRPs 1810 and 1910 arealigned, results in spurious parallax.

Another source of spurious parallax results from unequal focusing of theleft and right optical paths. Generally, any difference in focus betweenleft and right views may cause a perceived diminishment in image qualityand potential confusion over whether the left or right view shouldpredominate. If the focus difference is noticeable, it can result in anOut-Of-Focus (“OOF”) condition. OOF conditions are especially noticeablein stereoscopic images where left and right views are shown in the sameimage. In addition, OOF conditions are not easily correctable sincere-focusing an out-of-focus optical path usually results in the otheroptical path becoming unfocused. Generally, a point needs to bedetermined where both optical paths are in focus, which may includechanging positions of left and right lenses along an optical path and/oradjusting a working distance from the target site 700.

FIG. 22 shows a diagram illustrative of how an OOF condition develops.The diagram relates perceived resolution (e.g., focus) to a lensposition relative to an optimal resolution section 2202. In this examplethe left rear zoom lens 734 is at position L1 while the right rear zoomlens 732 is at position R1. At position L1 and R1, the rear zoom lenses732 and 734 are in a range of optimal resolution 2202 such that the leftand right optical paths have matched focus levels. However, there is adifference in the positions of L1 and R1, corresponding to distance ΔP.At a later time, the working distance 706 is changed such that a pointis out-of-focus. In this example, both rear zoom lenses 732 and 734 movethe same distance to locations L2 and R2 such that distance ΔP does notchange. However, the position change results in a significant change inresolution ΔR such that the left rear zoom lens 734 has a higherresolution (e.g., better focus) that the right rear zoom lens 732. Theresolution ΔR corresponds to the OOF condition, which results inspurious parallax from misalignment of focus between the right and leftoptical paths.

Yet another source of spurious parallax can result from imaging objectsthat are moving at the target site 700. The spurious parallax resultsfrom small synchronization errors between exposures of the right andleft optical image sensors 746 and 748. If the left and right views arenot recorded simultaneously, then the object appears to be displaced ormisaligned between the two views. The combined stereoscopic image showsthe same object at two different locations for the left and right views.

Moreover, another source of spurious parallax involves a moving ZRPpoint during magnification. The examples discussed above in SectionIV(A) assume that the ZRPs of the left and right views do not move inthe x-direction or the y-direction. However, the ZRPs may shift duringmagnification if the zoom lenses 726, 728, 732, and/or 734 do not moveexactly parallel with the optical path or axis (e.g., in thez-direction). As discussed above in reference to FIG. 11, the carrier724 may shift or rotate slightly when a force is applied to theactuation section 1108. This rotation may cause the left and right ZRPsto move slightly when a magnification level is changed.

In an example, during a magnification change, the carrier 730 moves in asingle direction while the carrier 724 moves in the same direction for aportion of the magnification change and in an opposite direction for aremaining portion of the magnification change for focus adjustment. Ifthe axis of motion of the carrier 724 is tilted or rotated slightly withrespect to the optical axis, the ZRP of the left and/or right opticalpaths will shift in one direction for the first portion followed by ashift in a reverse direction for the second portion of the magnificationchange. In addition, since the force is applied unequally, the right andleft front zoom lenses 726 and 728 may experience varying degrees of ZRPshift between the left and right optical paths. Altogether, the changein position of the ZRP results in misaligned optical paths, therebyproducing spurious parallax.

C. Reduction in Spurious Parallax Facilitates Incorporating DigitalGraphics and Images with a Stereoscopic View

As surgical microscopes become more digitalized, designers are addingfeatures that overlay graphics, images, and/or other digital effects tothe live-view image. For example, guidance overlays, fusion ofstereoscopic Magnetic Resonance Imaging (“MRI”) images, and/or externaldata may be combined with images recorded by a camera, or even displayedwithin oculars themselves. Spurious parallax reduces the accuracy of theoverlay with the underlying stereoscopic image. Surgeons generallyrequire, for example, that a tumor visualized via MRI be placed asaccurately as possible, often in three dimensions, within a fused livesurgical stereoscopic view. Otherwise, the preoperative tumor imageprovides little information to the surgeon, thereby detracting from theperformance.

For example, a surgical guide may be aligned with a right view imagewhile misaligned with the left view. The misaligned surgical guidebetween the two views is readily apparent to the operator. In anotherexample, a surgical guide may be aligned separately with left and rightviews in the information processor module 1408 prior to the graphicsprocessing unit 1564 creating the combined stereoscopic image. However,misalignment between the left and right views creates misalignmentbetween the guides, thereby reducing the effectiveness of the guides andcreating confusion and delay during the microsurgical procedure.

U.S. Pat. No. 9,552,660, titled “IMAGING SYSTEM AND METHODS DISPLAYING AFUSED MULTIDIMENSIONAL RECONSTRUCTED IMAGE,” (incorporated herein byreference) discloses how preoperative images and/or graphics arevisually fused with a stereoscopic image. FIGS. 23 and 24 show diagramsthat illustrate how spurious parallax causes digital graphics and/orimages to lose accuracy when fused to a stereoscopic image. FIG. 24shows a front view of a patient's eye 2402 and FIG. 23 shows across-sectional view of the eye along plane A-A of FIG. 24. In FIG. 23,the information processor module 1408 is instructed to determine acaudal distance d from a focus plane 2302 to, for example, an object ofinterest 2304 on a posterior capsule of the eye 2402. The informationprocessor module 1408 operates a program 1560 that specifies, forexample, that the distance d is determined by a triangulationcalculation of image data from the left and right views of the eye 2402.A view 2306 is shown from a perspective of the left optical image sensor748 and a view 2308 is shown from a perspective of the right opticalimage sensor 746. The left and right views 2306 and 2308 are assumed tobe coincident with an anterior center 2310 of the eye 2402. In addition,the left and right views 2306 and 2308 are two-dimensional views of theobject 2304 projected onto a focal plane 2302 as theoretical rightprojection 2312 and theoretical left projection 2314. In this example,processor 1562 determines the distance d to the object of interest 2304by calculating an intersection of an extrapolation of the theoreticalright projection 2312 and an extrapolation of the theoretical leftprojection 2314 using a triangulation routine.

However, in this example spurious parallax exists, which causes anactual left projection 2316 to be located to the left of the theoreticalleft projection 2314 by a distance P, as shown in FIGS. 23 and 24. Theprocessor 1562 uses the actual left projection 2316 and the rightprojection 2312 to determine a distance to an intersection 2320 of anextrapolation of the right projection 2312 and an extrapolation of theactual left projection 2316 using the triangulation routine. Thedistance of the intersection point 2320 is equal to the distance d plusan error distance e. The spurious parallax accordingly results in anerroneous distance calculation using data taken from a stereoscopicimage. As shown in FIGS. 23 and 24, even a small degree of spuriousparallax may create a significant error. In the context of a fusedimage, the erroneous distance may result in an inaccurate placement of atumor three-dimensional visualization for fusion with a stereoscopicimage. The inaccurate placement may delay the surgery, hinder theperformance of the surgeon, or cause the entire visualization system tobe disregarded. Worse yet, a surgeon may rely on the inaccurateplacement of the tumor image and make a mistake during the microsurgeryprocedure.

D. The Example Stereoscopic Visualization Camera Reduces or EliminatesSpurious Parallax

The example stereoscopic visualization camera 300 of FIGS. 3 to 16 isconfigured to reduce or eliminate visual defects, spurious parallax,and/or misaligned optical paths that typically result in spuriousparallax. In some examples, the stereoscopic visualization camera 300reduces or eliminates spurious parallax by aligning ZRPs of the left andright optical paths to the respective centers of pixel sets 1006 and1008 of the right and left optical image sensors 746 and 748.Additionally or alternatively, the stereoscopic visualization camera 300may align the optical paths of the left and right images. It should beappreciated that the stereoscopic visualization camera 300 may performactions to reduce spurious parallax during calibration. Additionally,the stereoscopic visualization camera 300 may reduce detected spuriousparallax in real-time during use.

FIGS. 25 and 26 illustrate a flow diagram showing an example procedure2500 to reduce or eliminate spurious parallax, according to an exampleembodiment of the present disclosure. Although the procedure 2500 isdescribed with reference to the flow diagram illustrated in FIGS. 25 and26, it should be appreciated that many other methods of performing thesteps associated with the procedure 2500 may be used. For example, theorder of many of the blocks may be changed, certain blocks may becombined with other blocks, and many of the blocks described areoptional. Further, the actions described in procedure 2500 may beperformed among multiple devices including, for example the opticalelements 1402, the image capture module 1404, the motor and lightingmodule 1406, and/or the information processor module 1408 of the examplestereoscopic visualization camera 300. For example, the procedure 2500may be performed by one of the programs 1560 of the informationprocessor module 1408.

The example procedure 2500 begins when the stereoscopic visualizationcamera 300 receives an instruction to align right and left optical paths(block 2502). The instructions may be received from the user inputdevice 1410 in response to an operator requesting that the stereoscopicvisualization camera 300 perform a calibration routine. In otherexamples, the instructions may be received from the informationprocessor module 1408 after determining right and left images aremisaligned. The information processor module 1408 may determine imagesare not aligned by executing a program 1560 that overlays right and leftimages and determines differences in pixel values, where greaterdifferences over large areas of pixels are indicative of misalignedimages. In some examples, the program 1560 may compare the pixel data ofthe left and right images without performing an overlay function, where,for example, left pixel data is subtracted from right pixel data todetermine a severity of misalignment.

After receiving instructions to reduce spurious parallax, the examplestereoscopic visualization camera 300 locates a ZRP of one of the leftor right optical path. For illustrative purposes, procedure 2500includes the ZRP of the left optical path being determined first.However, in other embodiments, the procedure 2500 may determine the ZRPof the right optical path first. To determine the left ZRP, thestereoscopic visualization camera 300 moves at least one zoom lens(e.g., the left front zoom lens 728 and/or the left rear zoom lens 734)to a first magnification level along a z-direction of the left opticalpath (block 2504). In instances where the front zoom lenses 726 and 728are connected to the same carrier 724 and the rear zoom lenses 732 and734 are connected to the same carrier 730, the movement of the leftlenses causes the right lenses to also move. However, only movement ofthe left lenses is considered during this section of the procedure 2500.

At the first magnification level, the stereoscopic visualization camera300 causes the left zoom lens to move along the z-direction (block2506). The movement may include, for example, back-and-forth movementaround the first magnification level. For example, if the firstmagnification level is 5×, the movement may be between 4× and 6×. Themovement may also include movement in one direction, such as from 5× to4×. During this movement, the stereoscopic visualization camera 300 mayadjust one or more other lenses to maintain focus of the target site700. At block 2508, during the movement of the left zoom lens, thestereoscopic visualization camera 300 records a stream or a sequence ofimages and/or frames 2509 of the target site 700 using, for example, theleft optical image sensor 748. The images 2509 are recorded using anoversized pixel set 1008 configured to encompass an origin of the pixelgrid 1004 and potential locations of the left ZRP.

The example processor 1562 of the information processor module 1408analyzes the image stream to locate a portion of area that does not movein an x-direction or a y-direction between the images (block 2510). Theportion of the area may include one or a few pixels and corresponds tothe left ZRP. As discussed above, during a magnification change, objectsmove away from the ZRP or move towards the ZRP. Only objects at the ZRPremain constant in position with respect to the field-of-view asmagnification changes. The processor 1562 may calculate deltas betweenthe stream of images for each pixel using pixel data. An area with thesmallest delta across the image stream corresponds to the left ZRP.

The example processor 1562 of the information processor module 1408 nextdetermines coordinates of a portion of the area that does not movebetween the image stream (e.g., determines a location of the left ZRP)with respect to the pixel grid 1004 (block 2512). In other examples, theprocessor 1562 of the information processor module 1408 determines adistance between the origin and the portion of the area corresponding tothe left ZRP. The distance is used to determine a position of the leftZRP on the pixel grid 1004. Once the location of the left ZRP isdetermined, the processor 1562 of the information processor module 1408determines a pixel set (e.g., the pixel set 1008) for the left opticalimage sensor 748 such that the left ZRP is located at a center (withinone pixel) of the pixel set (block 2514). At this point, the left ZRP iscentered within the left optical path.

In some examples, blocks 2504 to 2514 may be performed iteratively byre-selecting the pixel set until the left ZRP is within a pixel of theorigin and spurious parallax is minimized. After the pixel grid isdetermined, the processor 1562 of the information processor module 1408stores at least one of coordinates of the pixel set and/or coordinatesof the left ZRP to the memory 1570 as a calibration point (block 2516).The processor 1562 of the information processor module 1408 mayassociate the first magnification level with the calibration point suchthat the same pixel set is selected when the stereoscopic visualizationcamera 300 returns to the first magnification level.

FIG. 27 shows a diagram illustrative of how the left ZRP is adjustedwith respect to the pixel grid of the left optical image sensor 748.Initially, an initial (e.g., oversized) pixel set 2702 is selected,which is centered on origin 2704. The pixel set 2702 is large enough torecord potential ZRPs in the image stream. In this illustrated example,a left ZRP 2706 is located above and to the right of the origin 2704.The processor 1562 of the information processor module 1408 determinespixel set 2708 based on a location of the left ZRP 2706 such that theleft ZRP 2706 is located or positioned at a center of the pixel set2708.

After the left ZRP is determined and aligned with an origin of a pixelset in FIG. 25, the example procedure 2500 aligns the left and rightimages in FIG. 26. To align the images, the example processor 1562compares pixel data from left and right images recorded after the leftZRP is aligned with the origin. In some embodiments, the processor 1562overlays the left and right images to determine differences using, forexample, a subtraction and/or template method. The processor 1562selects or determines a pixel set for the right optical path such thatthe resulting right images align or coincide with the left images (block2519).

The example processor 1562, in the illustrated embodiment, determinesthe right ZRP. The steps are similar to steps discussed in blocks 2504to 2512 for the left ZRP. For example, at block 2518 the stereoscopicvisualization camera 300 moves a right zoom lens to the firstmagnification level. In some embodiments, the magnification level forthe right lens is different than the magnification level used fordetermining the left ZRP. The example processor 1562 of the informationprocessor module 1408 then moves the right zoom lens around themagnification level and receives a stream of images 2521 from the rightoptical image sensor 746 during the movement (blocks 2520 and 2522). Theexample processor 1562 of the information processor module 1408determines the right ZRP from the right stream of images by locating aportion of an area that does not move between the images (block 2524).The processor 1562 next determines coordinates of the right ZRP and/or adistance between a center of an aligned pixel set 1006 to the right ZRP(block 2526).

The processor 1562 then instructs the motor and lighting module 1406 tomove at least one lens in the right optical path in at least one of anx-direction, a y-direction, and/or a tilt-direction to align the rightZRP with the center of the aligned pixel set 1006 using, for example,the distance or coordinates of the right ZRP (block 2528). In otherwords, the right ZRP is moved to coincide with the center of the alignedpixel set 1006. In some examples, the right front lens 720, the rightlens barrel 736, the right final optical element 745, and/or the rightimage sensor 746 is moved (using for example a flexure) in thex-direction, the y-direction and/or a tilt-direction with respect to thez-direction of the right optical path. The degree of movement isproportional to the distance of the right ZRP from the center of thepixel set 1006. In some embodiments, the processor 1562 digitallychanges properties of the right front lens 720, the right lens barrel736, and/or the right final optical element 745 to have the same effectas moving the lenses. The processor 1562 may repeat steps 2520 to 2528and/or use subsequent right images to confirm the right ZRP is alignedwith the center of the pixel set 1006 and/or to iteratively determinefurther lens movements needed to align the right ZRP with the center ofthe pixel set.

The example processor 1562 stores coordinates of the right pixel setand/or the right ZRP to the memory 1570 as a calibration point (block2530). The processor 1562 may also store to the calibration point aposition of the right lens that was moved to align the right ZRP. Insome examples, the calibration point for the right optical path isstored with the calibration point for the left optical path inconjunction with the first magnification level. Thus, the processor 1562applies the data within the calibration point to the optical imagesensors 746 and 748 and/or radial positioning of one or more opticalelements 1402 when the stereoscopic visualization camera 300 issubsequently set to the first magnification level.

In some examples, the procedure 2500 may be repeated for differentmagnification levels and/or working distances. Accordingly, theprocessor 1562 determines if ZRP calibration is needed for anothermagnification level or working distance (block 2532). If anothermagnification level is to be selected, the procedure 2500 returns toblock 2504 in FIG. 25. However, if another magnification level is notneeded, the example procedure ends.

Each of the calibration points may be stored in a look-up-table. Eachrow in the table may correspond to a different magnification leveland/or working distance. Columns in the look-up-table may providecoordinates for the left ZRP, the right ZRP, the left pixel set, and/orthe right pixel set. In addition, one or more columns may specifyrelevant positions (e.g., radial, rotational, tilt, and/or axialpositions) of the lenses of the optical elements 1402 to achieve focusat the magnification level in addition to aligned right and left images.

The procedure 2500 accordingly results in the right ZRP and the left ZRPin addition to views of the target site to be aligned to pixel grids ofthe respective optical image sensors 746 and 748 as well as to eachother in a three-dimensional stereoscopic image. In some instances, theleft and right images and the corresponding ZRPs have an accuracy andalignment to within one pixel. Such accuracy may be observable on thedisplay 514 or 514 by overlaying left and right views (e.g., images fromthe left and right optical paths) and observing both views with botheyes, rather than stereoscopically.

It should be appreciated that in some examples, a right pixel set isfirst selected such that the right ZRP is aligned with or coincidentwith an origin of the pixel set. Then, the right and left optical imagesmay be aligned by moving one or more right and/or left lenses of theoptical elements 1402. This alternative procedure still provides rightand left ZRPs that are centered and aligned between each other and withrespect to the optical image sensors 746 and 748.

The procedure 2500 ultimately reduces or eliminates spurious parallax inthe stereoscopic visualization camera 300 throughout a full opticalmagnification range by ensuring left and right ZRPs remain aligned andthe right and left images remain aligned. In other words, the dualoptics of the right and left optical image sensors 746 and 748 arealigned such that parallax at a center of an image between the left andright optical paths is approximately zero at the focal plane.Additionally, the example stereoscopic visualization camera 300 is parfocal across the magnification range, and par central acrossmagnification and working distance ranges since the ZRP of each opticalpath has been aligned to a center of the respective pixel set.Accordingly, changing only the magnification will maintain a focus ofthe target site 700 in both optical image sensors 746 and 748 whilebeing trained on the same center point.

The above procedure 2500 may be performed at calibration before asurgical procedure is performed and/or upon request by an operator. Theexample procedure 2500 may also be performed prior to image registrationwith a pre-operative microsurgical image and/or surgical guidancegraphics. Further, the example procedure 2500 may be performed inreal-time automatically during operation of the stereoscopicvisualization camera 300.

1. Template Matching Example

In some embodiments, the example processor 1562 of the informationprocessor module 1408 is configured to use a program 1560 in conjunctionwith one or more templates to determine a position of the right ZRPand/or the left ZRP. FIG. 28 shows a diagram illustrative of how theprocessor 1562 uses a target template 2802 to determine a location of aleft ZRP. In this example, FIG. 28 shows a first left image includingthe template 2802 aligned with an origin 2804 or center of the leftpixel grid 1004 of the left optical image sensor 748. The template 2802may be aligned by moving the stereoscopic visualization camera 300 tothe appropriate location. Alternatively, the template 2802 may be movedat the target site 700 until aligned. In other examples, the template2802 may include another pattern that does not need alignment with acenter of the pixel grid 1004. For example, the template may include agraphical wave pattern, a graphical spirograph pattern, a view of asurgical site of a patient and/or a grid having visually distinguishablefeatures with some degree of non-periodicity in both the x andy-directions. The template is configured to prevent a subset of aperiodic image from being perfectly aligned onto the larger image in aplurality of locations, which makes such templates unsuitable formatching. A template image that is suitable for template matching isknown as a “template match-able” template image.

The template 2802 shown in FIG. 28 is imaged at a first magnificationlevel. A left ZRP 2806 is shown with respect to the template 2802. TheZRP 2806 has coordinates of L_(x), L_(y) with respect to the origin2804. However, at this point in time, the processor 1562 has not yetidentified the left ZRP 2806.

To locate the ZRP 2806, the processor 1562 causes a left zoom lens(e.g., the left front zoom lens 728 and/or the left rear zoom lens 734)to change magnification from the first magnification level to a secondmagnification level, specifically in this example, from 1× to 2×. FIG.29 shows a diagram of a second left image including the target 2802 onthe pixel grid 1004 with the magnification level doubled. From the firstmagnification level to the second magnification level, portions of thetarget 2802 increase in size and expand uniformly away from the left ZRP2806, which remains stationary with respect to the first and secondimages. In addition, a distance between the origin 2804 of the pixelgrid 1004 and the left ZRP 2806 remains the same.

The example processor 1562 synthesizes a digital template image 3000from the second image shown in FIG. 29. To create the digital templateimage, the processor 1562 copies the second image shown in FIG. 29 andscales the copied image by the reciprocal of the magnification changefrom the first to the second magnification. For example, if themagnification change from the first image to the second image was by afactor of 2, then the second image is scaled by ½. FIG. 30 shows adiagram of the digital template image 3000, which includes the template2802. The template 2802 in the digital template image 3000 of FIG. 30 isscaled to be the same size as the template 2802 in the first left imageshown in FIG. 28.

The example processor 1562 uses the digital template image 3000 tolocate the left ZRP 2806. FIG. 31 shows a diagram that shows the digitaltemplate image 3000 superimposed on top of the first left image (or asubsequent left image recorded at the first magnification level)recorded in the pixel grid 1004. The combination of the digital templateimage 3000 with the first left image produces a resultant view, asillustrated in FIG. 31. Initially the digital template image 3000 iscentered at the origin 2804 of the pixel grid 1004.

The example processor 1562 compares the digital template image 3000 tothe underlying template 2802 to determine if they are aligned ormatched. The example processor 1562 then moves the digital templateimage 3000 one or more pixels either horizontally or vertically andperforms another comparison. The processor 1562 iteratively moves thedigital template image 3000 compiling a matrix of metrics for eachlocation regarding how close the digital template image 3000 matches theunderlying template 2802. The processor 1562 selects the location in thematrix corresponding to the best matching metric. In some examples, theprocessor 1562 uses the OpenCV™ Template Match function.

FIG. 32 shows a diagram with the digital template image 3000 alignedwith the template 2802. The distance that the digital template image3000 was moved to achieve optimal matching is shown as Δx and Δy.Knowing the digital template image 3000 was synthesized at a scale ofM1/M2 (the first magnification level divided by the second magnificationlevel), the processor 1562 determines the coordinates (L_(x), L_(y)) ofthe left ZRP 2806 using Equations (1) and (2) below.L _(x) =Δx/(M1/M2)  Equation (1)L _(y) =Δy/(M1/M2)  Equation (2)

After the coordinates (L_(x), L_(y)) of the left ZRP 2806 aredetermined, the example processor 1562 selects or determines a pixelsubset with an origin that is aligned or coincides with the left ZRP2806, as discussed above in conjunction with procedure 2500 of FIGS. 25and 26. In some embodiments, the processor 1562 may use templatematching iteratively to converge on a highly accurate ZRP positionand/or pixel subset. Further, while the above example discussed locatingthe left ZRP, the same template matching procedure can be used to locatethe right ZRP.

In some embodiments, the above-described template matching program 1560may be used to align the left and right images. In these embodiments,left and right images are recorded at a magnification level. Both theimages may include, for example, the target template 2802 of FIG. 28. Aportion of the right image is selected and overlaid with the left image.The portion of the right image is then shifted around the left image byone or more pixels horizontally and/or vertically. The example processor1562 performs a comparison at each location of the portion of the rightimage to determine how close a match exists with the left image. Once anoptimal location is determined, a pixel set 1006 of the right pixel grid1002 is determined such that the right image is generally coincidentwith the left image. The location of the pixel set 1006 may bedetermined based on how much the portion of the right image was moved tocoincide with the left image. Specifically, the processor 1562 uses anamount of movement in the x-direction, the y-direction, and/or thetilt-direction to determine corresponding coordinates for the rightpixel set 1006.

2. Right and Left Image Alignment Example

In some embodiments, the example processor 1562 of the informationprocessor module 1408 of FIGS. 14 to 16 displays an overlay of right andleft images on the display monitor 512 and/or 514. The processor 1562 isconfigured to receive user feedback for aligning the right and leftimages. In this example each pixel data for the right and left images isprecisely mapped to a respective pixel of the display monitor 512 using,for example, the graphics processing unit 1564. The display of overlaidleft and right images makes any spurious parallax readily apparent to anoperator. Generally, with no spurious parallax, the left and rightimages should almost exactly align.

If an operator detects spurious parallax, the operator may actuatecontrols 305 or the user input device 1410 to move either the right orleft image for alignment with the other of the right and left image.Instructions from the controls 305 may cause the processor 1562 toaccordingly adjust the location of the left or right pixel set inreal-time, such that subsequent images are displayed on the displaymonitor 512 reflective of the operator input. In other examples, theinstructions may cause the processor 1562 to change a position of one ormore of the optical elements 1402 via radial adjustment, rotationaladjustment, axial adjustment, or tilting. The operator continues toprovide input via controls 305 and/or the user input device 1410 untilthe left and right images are aligned. Upon receiving a confirmationinstruction, the processor 1562 stores a calibration point to alook-up-table reflective of the image alignment at the set magnificationlevel.

Additionally or alternatively, the template match method described abovemay be used to perform image alignment while focused on a planar targetthat is approximately orthogonal to a stereo optical axis of thestereoscopic visualization camera 300. Moreover, the template matchmethod may be used to align the left and right views in real-timewhenever a “template match-able” scene is in view of both the left andright optical paths. In an example, a template image is copied from asubset of, for instance, the left view, centered upon or near the centerof the view. Sampling from the center for an in-focus image ensures thata similar view of the target site 700 will be present in the other view(in this example the right view). For out-of-focus images, this is notthe case such that in the current embodiment this alignment method isperformed only after a successful auto-focus operation. The selectedtemplate is then matched in the current view (or a copy thereof) of theother view (in this example the right view) and only a y-value is takenfrom the result. When the views are aligned vertically, the y-value ofthe template match is at or near zero pixels. A non-zero y-valueindicates vertical misalignment between the two views and a correctionusing the same value of y is applied either to select the pixel readoutset of the first view or a correction using the negated value of y isapplied to the pixel readout set of the other view. Alternatively, thecorrection can be applied in other portions of the visualizationpipeline, or split between pixel readout set(s) and said pipeline.

In some examples, the operator may also manually align a right ZRP withan origin of the pixel grid 1002. For instance, after determining alocation of the right ZRP, the processor 1562 (and/or the peripheralinput unit interface 1574 or graphics processing unit 1564) causes theright ZRP to be highlighted graphically on a right image displayed bythe display monitor 512. The processor 1562 may also display a graphicindicative of the origin of the pixel grid 1002. The operator usescontrols 305 and/or the user input device 1410 to steer the right ZRP tothe origin. The processor 1562 uses instructions from the controls 305and/or the user input device 1410 to accordingly move one or more of theoptical elements 1402. The processor 1562 may provide a stream of rightimages in real-time in addition to graphically displaying the currentlocation of the right ZRP and origin to provide the operator updatedfeedback regarding positioning. The operator continues to provide inputvia controls 305 and/or the user input device 1410 until the right ZRPis aligned. Upon receiving a confirmation instruction, the processor1562 stores a calibration point to a look-up-table reflective ofpositions of the optical elements 1402 at the set magnification level.

3. Comparison of Alignment Error

The example stereoscopic visualization camera 300 produces lessalignment error between right and left images compared to known digitalsurgical microscopes with stereoscopic cameras. The analysis discussedbelow compares spurious parallax generated by ZRP misalignment for aknown digital surgical microscope with camera and the examplestereoscopic visualization camera 300. Initially, both cameras are setat a first magnification level with a focal plane positioned on a firstposition of a patient's eye. Equation (3) below is used to determineworking distance (“WD”) from each camera to the eye.WD=(IPD/2)/tan(α)  Equation (3)

In this equation, IPD corresponds to the interpupillary distance, whichis approximately 23 mm. In addition, a is one-half of an angle between,for example, the right optical image sensor 746 and the left opticalimage sensor 748, which is 2.50° in this example. The convergence angleis two times this angle, which is 5°, in this example. The resultingworking distance is 263.39 mm.

The cameras are zoomed in to a second magnification level andtriangulated on a second position of the patient's eye. In this examplethe second position is at the same physical distance from the camera asthe first position, but presented at the second magnification level. Thechange in magnification generates spurious horizontal parallax due tomisalignment of one or both of the ZRPs with respect to a center of asensor pixel grid. For the known camera system, the spurious parallax isdetermined to be, for example, 3 arc-minutes, which corresponds to0.05°. In Equation (3) above, the 0.05° value is added to α, whichproduces a working distance of 258.22 mm. The difference in workingdistance is 5.17 mm (263.39 mm-258.22 mm), which corresponds to theerror of the known digital surgical microscope with camera attachment.

In contrast, the example stereoscopic visualization camera 300 iscapable of automatically aligning ZRPs to be within one pixel of acenter of a pixel set or grid. If the angular field-of-view is 5° andrecorded with a 4k image sensor used in conjunction with a 4k displaymonitor, the one pixel accuracy corresponds to 0.00125° (5°/4000) or 4.5arc-seconds. Using Equation (3) above, the 0.00125° value is added to α,which produces a working distance of 263.25 mm. The difference inworking distance for the stereoscopic visualization camera 300 is 0.14mm (263.39 mm-263.25 mm). When compared to the 5.17 mm error of theknown digital surgical microscope, the example stereoscopicvisualization camera 300 reduces alignment error by 97.5%.

In some embodiments, the stereoscopic visualization camera 300 may bemore accurate at higher resolutions. In the example above, theresolution is about 4.5 arc-seconds for a 5° field-of-view. For an 8Kultra-high definition system (with 8000 pixels in each of 4000 rows)with a field-of-view of 2°, the resolution of the stereoscopicvisualization camera 300 is approximately 1 arc-second. This means thatZRP of the left and right views may be aligned to one pixel or 1arc-second. This is significantly more precise than known digitalmicroscope systems that have spurious parallax on the order ofarc-minutes.

4. Reduction of Other Sources of Spurious Parallax

The above-examples discuss how the example stereoscopic visualizationcamera 300 reduces spurious parallax as a result of misaligned ZRPsand/or left and right images themselves. The stereoscopic visualizationcamera 300 may also be configured to reduce other sources of spuriousparallax. For example, the stereoscopic visualization camera 300 mayreduce spurious parallax due to motion by simultaneously clocking theright and left optical image sensors 746 and 748 to record images atsubstantially the same instant.

The example stereoscopic visualization camera 300 may also reducespurious parallax due to dissimilar magnification between the left andright optical paths. For example, the stereoscopic visualization camera300 may set the magnification level based on the left optical path. Thestereoscopic visualization camera 300 may then make automaticadjustments so that the magnification of the right image matches theleft. The processor 1562, for example, may use image data to calculatecontrol parameters, for example by measuring a number of pixels betweencertain features common in the left and right images. The processor 1562may then equalize the magnification levels of the left and right imagesby digital scaling, inserting interpolative pixels, and/or deletingextraneous pixels. The example processor 1562 and/or the graphicsprocessing unit 1564 may re-render the right image such that themagnification is matched to the left image. Additionally oralternatively, the stereoscopic visualization camera 300 may includeindependent adjustment of the left and right optical elements 1402. Theprocessor 1562 may separately control the left and right opticalelements 1402 to achieve the same magnification. In some examples, theprocessor 1562 may first set, for example, the left magnification levelthen separately adjust the right optical elements 1402 to achieve thesame magnification level.

The example stereoscopic visualization camera 300 may further reducespurious parallax due to dissimilar focus. In an example, the processor1562 may execute a program 1560 that determines a best focus for eachoptical path for a given magnification and/or working distance. Theprocessor 1562 first performs a focusing of the optical elements 1402 ata point of best resolution. The processor 1562 may then check the OOFcondition at a suitable non-object-plane location and match the focusfor the left and right images. The processor 1562 next re-checks thefocus at best resolution and adjusts the focus iteratively until bothleft and right optical elements 1402 focus equally well both on and awayfrom an object plane.

The example processor 1562 may measure and verify optimal focus bymonitoring a signal relating to the focus of one or both of the rightand left images. For example, a “sharpness” signal is generated by thegraphics processing unit 1564 for the left and right imagessimultaneously and/or in synchronization. The signal changes as focuschanges and may be determined from an image-analysis program, an edgedetection analysis program, a bandwidth of Fourier transforms of patternintensity program, and/or a modulation transfer function (“MTF”)measurement program. The processor 1562 adjusts a focus of the opticalelements 1402 while monitoring for a maximum signal indicative of asharp image.

To optimize the OOF condition, the processor 1562 may monitor sharpnesssignals for both the left and right images. If the focus is moved off ofthe object plane and the signal related to, for example, the left imageincreases but the signal related to the right image decreases, theprocessor 1562 is configured to determine the optical elements 1402 aremoving out of focus. However, if the signals related to both the rightand left images are relatively high and approximately equal, theprocessor 1562 is configured to determine the optical elements 1402 areproperly positioned for focusing.

5. Benefits of Low Spurious Parallax

The example stereoscopic visualization camera 300 has a number ofadvantages over known digital surgical microscopes as a result of thelow spurious parallax between right and left images. For example, almostperfectly aligned left and right images produce an almost perfectstereoscopic display for a surgeon, thereby reducing eye fatigue. Thisallows the stereoscopic visualization camera 300 to be used as anextension of a surgeon's eyes rather than a cumbersome tool.

In another example, precisely aligned left and right images allowaccurate measurements of the surgical site to be digitally taken. Forinstance, a size of a patient's ocular lens capsule may be measured suchthat a properly-sized IOL can be determined and accurately implanted. Inanother instance, a motion of a moving blood vessel may be measured suchthat an infrared fluorescein overlay can be accurately placed in a fusedimage. Here, the actual motion velocity is generally not of interest tothe surgeon but critical for the placement and real-time adjustment ofthe overlaid image. Properly matched scale, registration, andperspective of the overlaid images are all important to provide anaccurately-fused combined live stereoscopic image and an alternate-modeimage.

In some examples, the processor 1562 may enable an operator to drawmeasurement parameters on the display monitor 512. The processor 1562receives the drawn coordinates on a screen and accordingly translatesthe coordinates to the stereoscopic image. The processor 1562 maydetermine measurement values by scaling the drawn ruler on the displaymonitor 512 to a magnification level shown in the stereoscopic images.The measurements made by the processor 1562 include point-to-pointmeasurements of two or three locations displayed in the stereoscopicdisplay, point-to-surface measurements, surface characterizationmeasurements, volume determination measurements, velocity verificationmeasurements, coordinate transformations, instrument and/or tissuetracking, etc.

VII. Fluorescence Visualization Embodiment

As discussed above in connection with FIGS. 7, 8, 14, and 15 the examplestereoscopic visualization camera 300 includes one or more lightingsources including a visible light source 708 a, a near-infrared (“NIR”)light source 708 b, and a near-ultraviolet (“NUV”) light source 708 c.The stereoscopic visualization camera 300 also includes a filterassembly 740 that can accommodate three different optical filter pairs.For example, the filter assembly 740 can include an infrared cut filter,a near-infrared bandpass filter, and a near-ultraviolet cut filter. Thedifferent filter types are selected to work with different spectra ofthe light sources 708 and the reflectivity and transmissivitycharacteristics of the deflecting element 712 to pass certain desiredwavelengths of light at predetermined times. Synchronization between thelight sources 708 and the filter 740 may be performed by the motor andlighting controller 1520 and/or the processor 1562 of FIG. 15.

In some examples, each of the light sources 708 may be provided by asingle LED, two LEDs, three, LEDs, etc. The NUV light source 708 c mayinclude, for example, three 405 nm LEDs. The drivers 1534, 1536, and1538 of FIG. 15 are configured to provide a constant current source andadjust light intensity via pulse width modulation. In some examples,each of the light sources 708 may consume nine watts of power, threewatts for each LED.

FIG. 33 shows a diagram of the filter assembly 740 of FIGS. 7 and 8,according to an example embodiment of the present disclosure. The filterassembly 740 includes a first support section 3302 a and a secondsupport section 3302 b. Each of the sections 3302 is configured tomechanically couple to the housing 302 or other internal structure ofthe stereoscopic visualization camera 300. The support sections 3302 areconfigured to retain an axle 3304 therebetween. A center portion of theaxle 3304, located between the support sections 3302, is configured toinclude or support filter magazines 3306 a and 3306 b. In theillustrated example, a filter magazine 3306 is provided for each of theleft and right optical paths. In other embodiments, a single filtermagazine 3306 may be provided for both the left and right optical paths.

The example filter magazines 3306 are configured to connect to the axle3304 at a center portion. The axle 3304 may be configured to passthrough or be reflected around the center portion of the magazines 3306while enabling light to pass through the assembly 740. In otherexamples, the axle 3304 does not pass through the filter magazines 3306and instead is partitioned into pieces between the magazines 3306 andthe support sections 3302. In these examples the filtered light passesthrough a center of the magazines 3306. In some embodiments, the filtermagazines 3306 may be mechanically and/or chemically connected to theaxle 3304. In other examples, the filter magazines 3306 may include oneor more gaskets or other elastomeric couplers that provide for a secureconnection with the axle 3304. Positioning of both of the filtermagazines 3306 on the same axle 3304 enables both magazines 3306 to berotated around a rotation axis at the same speed and in the samedirection for the same duration. In other examples, the filter magazines3306 may be connected to separate axles for individual rotation control.

As shown in FIG. 33, each of the filter magazines 3306 includes aplurality of windows configured to accept or secure in place a lightfilter. For example, window 3308 a of the filter magazine 3306 a isconfigured to hold or secure in place light filter 3310 a, while window3308 b of the filter magazine 3306 b is configured to hold or secure inplace light filter 3310 b. Each of the example filter magazines 3306includes six sides for accepting six filters. The filters 3310 have adiameter between 5 mm and 20 mm, preferably around 9 mm. In otherexamples, the filter magazines 3306 may include fewer sides and filtersor additional sides and filters. Each of the filters 3310 include a lensthat is colored or coated such that only light of certain wavelengthsmay pass through. The filters 3310 enable, for example, lightcorresponding to fluorescence emission wavelengths to pass through whileblocking non-emission wavelengths, including visible light.

The example filter magazines 3306 are arranged on the axle 3304 suchthat they are perfectly or substantially aligned. Each of thecorresponding sides of the filter magazines are configured to have thesame filter type such that the same filter type is applied to light inboth the left and right optical paths. For example, each of the lightfilters 3310 a and 3310 b may either be an infrared cut filter, anear-infrared bandpass filter, or a near-ultraviolet cut filter.

In some examples, six light filters 3310 are provided at the respectivesix sides of the filter magazine 3306. The light filters may be alignedsuch that the filter magazine 3306 has a side with a light filter thatreceives light and an adjacent or opposing side of the same filter type.In instances where light passes through the filter magazine 3306 withoutdeflection, parallel, opposing sides are provided light filters of thesame type. Alternatively, a first side may have one of the filter typeswhile the parallel, opposing side has a clear lens that does not providelight filtering. In some embodiments, the clear lens may be replacedwith the left or right single optical element 745 or 747 of FIGS. 7 and8. In these embodiments, filters of different types are placed adjacentto each other.

In instances where the filter magazine 3306 includes internal deflectingelements, the deflecting elements are configured to refract or deflectlight that passes in one side of the magazine 3306 such that the lightis propagated through an adjacent side of the magazine 3306. As such,filters of the same type may be placed adjacent to each other.

The example axle 3304 is rotated via a gear 3312, which is linked to agear 3314 of a drive axle 3316. Rotation of the drive axle 3316 causesthe gear 3314 to rotate, which causes the gear 3312 and correspondingaxle 3304 to rotate in the same manner. The drive axle 3316 ismechanically coupled to a filter motor (not shown), which is controlledby the filter magazine motor driver 1540 of FIG. 15. The use of thedrive axle 3316 prevents, for example, force or torque from a drivemotor from providing force on the filter magazine 3306 and/or thecorresponding light filters 3310. The motor is configured to rotate thefilter magazines 3306 at a rate sufficient enough to enable 120 framesto be recorded per second by the image sensors 746 and 748. Each framemay require an 8.33 microsecond exposure time. In instances, where animage is created using visible light and fluorescence emission light,the motor provides quick rotational movement between two differentfilter positions, while dwelling at each position for 8.33 microsecondsbefore changing positions again.

FIG. 34 shows another embodiment of the filter assembly 740 of FIGS. 7and 8, according to an example embodiment of the present disclosure. Thefilter assembly 740 is shown as a wheel. In other embodiments, thefilter assembly 740 may be configured as a ring or a turret. In theillustrated embodiment, the filter assembly 740 includes an axle 3402directly connected to a motor. The filter assembly 740 also includes afirst panel 3404 and a second panel 3406 that are parallel to eachother. The axle 3402 is configured to pass through a center of thepanels 3404 and 3406 to enable the panels to be rotated around an axisof rotation.

Each of the panels 3404 and 3406 include six windows 3308 to hold inplace respective light filters. In addition, the panels 3404 and 3406are separated from each other by a certain distance. In an embodiment,light filters may be placed in the windows 3308 of the first panel 3404while clear lenses are placed in windows 3308 of the second panel 3406.In another embodiment, filters are placed in the windows 3308 of thefirst panel 3404 and the second panel 3406. The windows on the panels3404 and 3406 are aligned to enable at least some light to pass through.

In some instances, the panels 3404 and 3406 are configured to receivelight from both the left and right optical paths. For example, lightfrom the left and right optical paths may be received at opposingwindows of the same panel. In other instances, each of the left andright optical paths may have a separate filter assembly 740.

In other embodiments, the filter assembly 740 includes an opticaldirecting device, such as movable mirrors. The directing device isconfigured to deflect light to one or more potential paths that each hasa different light filter. The mirrors may be rotated or otherwise movedby respective motors or actuators. After filtering, the light isdeflected to respective image sensors 746 and 748 and/or the finaloptical element set 742.

The following sections describe how the stereoscopic visualizationcamera 300 is configured to provide for different fluorescence modes bycontrolling activation of certain light sources 708 with one or morelight filters of the filter assembly 740. While the disclosure is inreference to indocyanine green (“ICG”) and 5-aminolevulinic acid (“ALA”)fluorescence, it should be appreciated that that the stereoscopicvisualization camera 300 may be configured for other types offluorescence and/or lighting modes. For example, transmissionwavelengths of the light sources 708 may be changed and/or the filterassembly 740 can be configured with different light filters to providefor different lighting modes.

A. Indocyanine Green (“ICG”) Embodiment

ICG is a cyanine dye used to observe perfusion within a patient's body.In some instances, ICG may be used for performing angiography.Generally, ICG is useful for imaging or differentiating blood vesselsfrom other tissue. ICG is used in medical applications as a result ofits response to Near Infrared (“NIR”) light when bonded to proteins in apatient's blood. The ICG absorbs light having wavelengths between 710nm-822 nm, with peak absorption between 800-810 nm. Generally, lightfrom a light source that provides light having a wavelength between 710nm-822 nm causes the ICG (bonded to protein) to emit a light in thespectral range of 755 nm-880 nm, with a peak between 830 nm-832 nm. Assuch, photons from an excitation light source that have the samewavelength as the absorption wavelengths of ICG interact with the ICG,thereby causing the emission of light having a shifted wavelength.

Most humans cannot perceive light that has a wavelength above 700 nm. Asa result, humans cannot view the emission of ICG fluorescence.Conventional known vision systems attempt to solve this problem by beingsensitive in the NIR light spectrum. For instance, a conventionalmicroscope uses a two-dimensional infrared camera, which is attached asan accessory. The known accessory cameras lack resolution and do notprovide depth perception since they provide only two-dimensional video.The recorded video suffers from light loss since the camera is attachedto an optical splitter, such as the splitter described in connectionwith FIG. 2. The loss of light makes it very difficult for a camera tovisualize deep cavities. As a result of these limitations, accessorycameras may only have a working distance limit of 300 mm.

In an attempt to reduce the drawbacks, known conventional microscopeswith accessory cameras tend to be large, heavy, and generate significantamounts of heat at the target surgical site, which is not ideal for thepatient. The additional heat generated by increasing light intensity tocompensate for the added camera and lack of depth perception often timescauses surgical work on the patient to be paused during ICG excitation.Further, these systems tend to lose fluorescence visualization due toreduced resolution at magnification settings greater than 5× and arelimited to smaller illumination field diameters resulting from lessillumination power distribution over the surgical area. As a result ofthese deficiencies, many surgeons do not use conventional microscopesfor ICG fluorescent visualization if it is not needed.

The example stereoscopic visualization camera 300 disclosed hereinovercomes at least some of the known problems of conventionalmicroscopes by synchronizing light source activation and filterselection to optimize the reception of ICG emission light. FIG. 35 showsan embodiment illustrative of how the stereoscopic visualization camera300 uses the NIR light source 708 b with the filter assembly 740 forproviding light corresponding to ICG emission wavelengths to the imagesensors 746 and 748, according to an example embodiment of the presentdisclosure.

In the illustrated example, an operator selects an NIR mode of thestereoscopic visualization camera 300. The operator may select the NIRmode using controls on the arms 304 and/or via an input device 1410. Themotor and lighting controller 1520 and/or the processor 1562 of FIG. 15receives the request for NIR mode and transmits one or more messages orsignals to the NIR light driver 1536 for activating the NIR light source708 b and/or the visible light driver 1538 to activate the visible lightsource 708 a. The motor and lighting controller 1520 and/or theprocessor 1562 may also deactivate the other light sources 708 a and/or708 c. In addition to activating the NIR light source 708 b, the motorand lighting controller 1520 and/or the processor 1562 cause the filterassembly 740 to rotate the left and right filter magazines 3306 to causenear-infrared bandpass filters to be placed in the left and rightoptical paths.

In some embodiments, the motor and lighting controller 1520 and/or theprocessor 1562 use one or more zoom lookup tables to cause the frontzoom lens set 724 and/or rear zoom lens set 730 to move along theoptical path to maintain focus. The movement may be only a few micronsto account for a different focal point (compared to visible light) as aresult of longer wavelengths associated with infrared light. The zoomlookup table enables the same front zoom lens set 724 and/or rear zoomlens set 730 to be used for focusing both visible and IR light onto theimage sensors 746 and 748 without having to move the image sensorsfurther away to account for the wavelength differences. In someembodiments, the motor and lighting controller 1520 and/or the processor1562 may also adjust a position of the front working distance lens 408and/or the rear working distance lens 704 to improve focus for light inthe IR spectrum. Additionally or alternatively, the motor and lightingcontroller 1520 and/or the processor 1562 may adjust settings of theimage sensors 746 and 748 to improve sensitivity to light in the ICGwavelength range.

As shown in the illustrated example of FIG. 35, excitation light 3502transmits through an excitation filter 3508 that is configured to removea large percentage or portion of the excitation light that is within thesame wavelength range as that of the emissions filter of the filterassembly 740. In other words, the excitation filter 3508 permits lightbetween, for example 730 nm to 820 nm (or 738 nm to 802) nm to pass,corresponding to the absorption wavelength range of ICG, while blockinglight having wavelengths above 802 nm or 820 nm (and below 730 nm insome embodiments) to prevent contamination with excitation light havinga wavelength above 820 nm. As such, as shown in FIG. 35 any excitationlight 3502 that propagates to the end of the optical path due toreflections in the main objective assembly 702 (or from the targetsurgical site 700, shown as exited and emissions light 3504) is blockedby the excitation filter (e.g., the near-infrared bandpass filter) ofthe filter assembly 740 so that only ICG emissions light 3506 (e.g.,light having a wavelength between 817 nm to 900 nm) is received at theimage sensors 746 and 748 (collectively optical image sensor 744).

It should be appreciated that the image sensors 746 and 748 of thestereoscopic visualization camera 300 have a greater resolution thanIR-specific cameras used as accessories in conventional microscopes. Thegreater resolution of the image sensors 746 and 748 produces sharperimages with move overall detail. Further, the use of left and rightimage sensors 746 and 748 provides three-dimensional images with depth,which enables a surgeon to safely maneuver instruments in the surgicalarea while viewing the video on the display monitor 512, 514. The use ofsingle left and right optical paths eliminates the need for opticalsplitters of known microscopes, thereby decreasing system complexity,cost, and light loss. The maximization of light throughput to the imagesensors 746 and 748 enables the stereoscopic visualization camera 300 touse less powerful illumination (e.g., 20 to 25 watts) compared to knownmicroscopes, which use up to 400 watts and need to operate at 80% to100% for proper fluorescence. The use of less light (and powergenerally) generates less heat at the surgical site, thereby reducingthe risk of burning or overheating patient tissue, which reduces theamount of external hydration that needs to be applied to the surgicalsite.

It should also be appreciated that the light sources 708 of thestereoscopic visualization camera 300 are positioned relative to themain objective assembly 702 to provide semi-coaxial illumination, whichincreases the amount of light that can reach into deep cavities. Assuch, the example stereoscopic visualization camera 300 has little or nomagnification or working distance restrictions and can visualize ICGfluorescence up to 10× or 20× through the entire working distancebetween 200 mm-450 mm. The stereoscopic visualization camera 300provides a wide illumination field by default since the focusing isperformed by the main objective assembly 702 and/or the zoom assembly716 rather than in independent optics found in known conventionalmicroscopes.

In some embodiments, the stereoscopic visualization camera 300 isconfigured to provide back-illumination using visible light whilevisualizing ICG emission light. In known conventional microscopes, whena surgeon is viewing ICG emission light, the surrounding areas that arenot emitting light are completely dark, making it very difficult for thesurgeon to introduce or move their instrument at the target surgicalsite. The stereoscopic visualization camera 300 may switch between thevisible light source 708 a and the NIR light source 708 b while havingthe near-infrared bandpass filter of the filter assembly 740 engagedwith the optical paths. The stereoscopic visualization camera 300 mayalternatively activate the visible light source 708 a at the same timeas the NIR light source 708 b. While the light sources 708 a and 708 bare activated, the image sensors 746 and 748 record the ICG emissionlight for stereoscopic display. In this manner, the addition of thevisible spectrum light enables the surgeon to see surrounding tissuewhile still being able to view the fluorescing vascular system in realtime via the stereoscopic visualization on the display monitor 512 and514.

In some embodiments, the motor and lighting controller 1520 and/or theprocessor 1562 is configured to display a live stereoscopic view ofvisible light and ICG fluorescence at the same time. In theseembodiments, the motor and lighting controller 1520 and/or the processor1562 is configured to synchronize the filter assembly 740 to rotatebetween alternative positions for a first filter and a second filter asthe light sources are activated. FIG. 36 shows a diagram of an exampleprocedure 3600 for providing a live stereoscopic view of visible lightand ICG fluorescence at the same time, according to an exampleembodiment of the present disclosure. The example procedure 3600 may bedefined by one or more instructions stored in the memory 1524 and/or thememory 1570. The instructions are executable by the motor and lightingcontroller 1520 and/or the processor 1562 to perform the operationsdisclosed herein. It should be appreciated that in some embodiments, theother of the blocks may be different, certain blocks may be omitted,and/or blocks may be added.

The example procedure 3600 begins when the motor and lighting controller1520 and/or the processor 1562 receives an indication that an ICGfluorescence mode of the stereoscopic visualization camera 300 has beenactivated by an operator (block 3602). The indication may include amessage or signal from, for example, the input device 1410 of FIGS. 14and 15. As described herein, the ICG fluorescence mode includessuperimposing fluorescence graphics from a fluorescence scene onto avisible light scene during a visible light mode. To acquire one or morevideo frames or signals for the visible light scene, the motor andlighting controller 1520 and/or the processor 1562 causes the visiblelight source 708 a to be activated (block 3604) and causes the filterassembly 740 to rotate to the infrared cut filter or thenear-ultraviolet cut filter (block 3606). During this time, visiblelight is reflected from a surgical site 700 and received at the imagesensors 746 and 748, which convert the received light to image data(block 3608). The processor 1562 and/or a graphics processing unit 1564then combine the left and right image data into stereoscopic videosignals and/or video data for display on a monitor as the visible lightscene (block 3610). The motor and lighting controller 1520 and/or theprocessor 1562 continues to remain in the visible light mode for atleast the exposure time for one frame.

At a designated time, the motor and lighting controller 1520 and/or theprocessor 1562 acquires one or more video frames or signals for thefluorescence light scene by switching to a fluorescence mode. The motorand lighting controller 1520 and/or the processor 1562 switches fromvisible light mode to fluorescence mode by causing at least one of thevisible light source 708 a and/or the NIR light source 708 b to beactivated (block 3612) and causes the filter assembly 740 to rotate tothe ICG emissions filter (e.g., the near-infrared bandpass filter)(block 3614). The switching of modes may be performed during a blankingtime of the image sensors 746 and 748. During the fluorescence mode,mixed excitation and emissions light is reflected from a surgical site700 and filtered to ICG emission light, which is received at the imagesensors 746 and 748 for conversion to image data (block 3616). Theprocessor 1562 and/or the graphics processing unit 1564 then combine theleft and right image data into stereoscopic video signals and/or videodata as the fluorescence light scene (block 3618). The processor 1562and/or the graphics processing unit 1564 may visualize the areas in thevideo image that correspond to fluorescence light by applying at leastone graphic or changing pixel colors to a light wavelength that isviewable to an operator. The motor and lighting controller 1520 and/orthe processor 1562 continues to remain in the fluorescence light modefor at least the exposure time for one frame.

The processor 1562 and/or the graphics processing unit 1564 is alsoconfigured to combine the fluorescence video with the visible lightvideo. In some embodiments, this includes overlaying the fluorescencevideo frame on top of the visible light video frames (e.g., combiningthe separate visible and fluorescence images into a single image bylaying the fluorescence image over the visible image). In otherembodiments, the processor 1562 and/or the graphics processing unit 1564is configured to extract the portions of the fluorescence video frame(or the created fluorescence graphics) that comprise fluorescenceportions, identify corresponding locations in the visible light videoframes using, for example, shape or feature matching, and superimpose oroverlay the fluorescence portions on top of the corresponding visiblelight portions. The processor 1562 and/or the graphics processing unit1564 may also use pixel locations in a display coordinate plane suchthat the pixels from the fluorescence image data are displayed in thesame location over the visible light image data. For instance, if apixel from fluorescence image data is located in an image plane of (45,92) (corresponding to a pixel color value of fluorescence emissionlight), the processor 1562 and/or the graphics processing unit 1564shades the pixel to a color visible to a human operator and overlays orreplaces a pixel at the location (45, 92) of the visible light imagedata with the shaded pixel from the fluorescence image data.

The combined video is then provided for display showing areas of tissuewith fluorescence superimposed on the visible video. This configurationprovides a surgeon an improved view of the surrounding tissue while alsohighlighting, for example, fluorescing vessels. After the video signalsare displayed, the procedure returns to block 3604 to acquire additionalvisible video frames. The example procedure 3600 continues until thefluorescence mode is disabled or deactivated.

It should be appreciated that the motor and lighting controller 1520and/or the processor 1562 may acquire alternating frames in the visiblelight and fluorescence modes. As such, the video frame rate may bereduced since at least some of the video acquired during thefluorescence mode is combined with the visible light video frames. Toimprove the frame rate, the ratio of visible light frames tofluorescence light frames may be increased, where, for example, thefluorescence frames provide a sampling of the fluorescence data. Forexample, the motor and lighting controller 1520 and/or the processor1562 may be configured to acquire two, three, four, five, etc. visiblelight frames for every fluorescence light frame acquired. In theseembodiments, fluorescence video from one frame is combined with multiplevisible video frames.

In some embodiments, the motor and lighting controller 1520 and/or theprocessor 1562 are configured to provide an option for an operator toview side-by-side fluorescence and visible light views. In someinstances, the image may be stereoscopic, where a first video displayshows the visible light view, while an adjacent video display shows thefluorescence view. In these instances, the visible light view andfluorescence views are at least one frame apart.

In other examples, the filter assembly 740 may be configured to enabledifferent filters to be selected for the left and right views. Forexample, the infrared-cut filter or the near-ultraviolent cut filter maybe selected for the right optical path to provide visible light to theright image sensor 746 while the near-infrared bandpass filter isselected for the left optical path to provide ICG excitationfluorescence light to the left image sensor 748. In this configuration,the processor 1562 and/or the graphics processing unit 1564 produces twotwo-dimensional displays, one display being the visible light view andthe other being the fluorescence view.

B. 5-Aminolevulinic Acid (“ALA”) Embodiment

5-ALA is an amino acid that is orally digested six to eight hours by apatient prior to surgery. After ingestion, 5-ALA is transported in theblood stream throughout the body and is a precursor for ProtoporphyrinIX. With 5-ALA, glioblastomas metabolize in higher quantity compared tohealthy tissue Protoporphyrin IX, which reacts to light in the spectralrange of 300 nm-640 nm, with the strongest sensitivity between 400nm-415 nm. Reactions between Protoporphyrin IX with 5-ALA and lighthaving wavelengths in the range of 300 nm-640 nm causes or creates arelease of photos in the spectral range of 480 nm-800 nm, peaking at 635nm, with a smaller peak at 705 nm (viewed as a pinkish red glow).

Known microscopes have issues imaging 5-ALA fluorescence light that aresimilar to the issues for imaging ICG fluorescence light, discussedabove. The issues include bulky filters, excessive powerconsumption/heat generation, inefficient light splitting, and lessresolution two-dimensional video.

The example stereoscopic visualization camera 300 disclosed hereinovercomes at least some of the known problems of conventionalmicroscopes by synchronizing light source activation and filterselection to optimize the reception of 5-ALA emission light. FIG. 37shows an embodiment illustrative of how the stereoscopic visualizationcamera 300 uses the NUV light source 708 c with the filter assembly 740for providing light corresponding to 5-ALA emission wavelengths to theimage sensors 746 and 748, according to an example embodiment of thepresent disclosure.

In the illustrated example, an operator selects an NUV mode of thestereoscopic visualization camera 300. The operator may select the NUVmode using controls on the arms 304 and/or via an input device 1410. Themotor and lighting controller 1520 and/or the processor 1562 of FIG. 15receives the request for NUV mode and transmits one or more messages orsignals to the NUV light driver 1534 for activating the NV light source708 c. The motor and lighting controller 1520 and/or the processor 1562may also deactivate the other light sources 708 a and/or 708 b. Inaddition to activating the NUV light source 708 c, the motor andlighting controller 1520 and/or the processor 1562 cause the filterassembly 740 to rotate the left and right filter magazines 3306 to causenear-ultraviolet cut filters to be placed in the left and right opticalpaths.

Similar to the ICG fluorescence mode, the motor and lighting controller1520 and/or the processor 1562 use one or more zoom lookup tables tocause the front zoom lens set 724 and/or rear zoom lens set 730 to movealong the optical path to maintain focus. The motor and lightingcontroller 1520 and/or the processor 1562 may also adjust a position ofthe front working distance lens 408 and/or the rear working distancelens 704 to improve focus for light in the NUV spectrum (e.g., lighthaving a wavelength between 375 nm and 450 nm). Additionally oralternatively, the motor and lighting controller 1520 and/or theprocessor 1562 may adjust settings of the image sensors 746 and 748 toimprove sensitivity to light in the 5-ALA emission wavelength range.

As shown in the illustrated example of FIG. 37, excitation light 3702transmits through an excitation filter 3708 that is configured to removea large percentage or portion of the excitation light that is within thesame wavelength range as that of the near-ultraviolet cut filters of thefilter assembly 740. In other words, the excitation filter 3708 permitslight between, for example 300 nm-450 nm (or 380 nm to 450 nm) to pass,corresponding to the peak absorption wavelength range of 5-ALA, whileblocking light having wavelengths above 450 nm (and below 380 nm in someembodiments) to prevent contamination with excitation light having awavelength above 480 nm (e.g., light having a peak emission wavelengthof 635 nm). As such, as shown in FIG. 37 any excitation light 3702 thatmakes its way towards the end of the optical path due to reflections inthe main objective assembly 702 (or from the target surgical site 700,shown as exited and emissions light 3704) is blocked by the excitationfilter (e.g., the near-ultraviolet cut filter) of the filter assembly740 so that only 5-ALA emissions light 3706 is received at the imagesensors 746 and 748 (collectively optical image sensor 744).

It should be appreciated that the image sensors 746 and 748 of thestereoscopic visualization camera 300 have a greater resolution thanUV-specific cameras used as accessories in conventional microscopes. Thegreater resolution of the image sensors 746 and 748 produces sharperimages with move overall detail. Further the use of left and right imagesensors 746 and 748 provides three-dimensional images with depth, whichenables a surgeon to safely maneuver instruments in the surgical areawhile viewing the video on the display monitor 512, 514. Themaximization of light throughput to the image sensors 746 and 748enables the stereoscopic visualization camera 300 to use less powerfulillumination compared to known microscopes. The use of less light (andpower generally) generates less heat at the surgical site, therebyreducing the risk of burning or overheating patient tissue, whichreduces the amount of external hydration that needs to be applied to thesurgical site. In addition, since the stereoscopic visualization camera300 cuts off all blue light in the left and right optical paths, thestereoscopic image has higher contrast between a tumor and healthytissue compared to contrast provided by conventional microscopes.

It should also be appreciated that the light sources 708 of thestereoscopic visualization camera 300 are positioned relative to themain objective assembly 702 to provide semi-coaxial illumination, whichincreases the amount of light that can reach into deep cavities. Assuch, the example stereoscopic visualization camera 300 has little or nomagnification or working distance restrictions and can visualize 5-ALAfluorescence up to 10× or 20× through the entire working distancebetween 200 mm-450 mm. The stereoscopic visualization camera 300provides a wide illumination field by default since the focusing isperformed by the main objective assembly 702 and/or the zoom assembly716 rather than in independent optics found in known conventionalmicroscopes.

In some embodiments, the stereoscopic visualization camera 300 isconfigured to provide back-illumination using visible light whilevisualizing 5-ALA emission light for viewing of surrounding tissue andtools from a tumor. In known conventional microscopes, when a surgeon isviewing 5-ALA emission light, the surrounding areas that are notemitting light are completely dark, making it very difficult for thesurgeon to introduce or move their instrument at the target surgicalsite. The stereoscopic visualization camera 300 may switch between thevisible light source 708 a and the NUV light source 708 c while havingthe near-ultraviolet cut filter of the filter assembly 740 engaged withthe optical paths. The stereoscopic visualization camera 300 mayalternatively activate the visible light source 708 a at the same timeas the NUV light source 708 c. While the light sources 708 a and 708 bare respectively activated, the image sensors 746 and 748 record the5-ALA emission light for stereoscopic display. In this manner, theaddition of the visible spectrum light enables the surgeon to seesurrounding tissue while still being able to view the fluorescing tumorin real time via the stereoscopic visualization on the display monitor512 and 514.

In some embodiments, the motor and lighting controller 1520 and/or theprocessor 1562 is configured to display a live stereoscopic view ofvisible light and 5-ALA fluorescence at the same time. In theseembodiments, the motor and lighting controller 1520 and/or the processor1562 is configured to synchronize the filter assembly 740 to rotatebetween alternative positions for a first filter and a second filter asthe light sources are activated. FIG. 38 shows a diagram of an exampleprocedure 3800 for providing a live stereoscopic view of visible lightand 5-ALA fluorescence at the same time, according to an exampleembodiment of the present disclosure. The example procedure 3800 may bedefined by one or more instructions stored in the memory 1524 and/or thememory 1570. The instructions are executable by the motor and lightingcontroller 1520 and/or the processor 1562 to perform the operationsdisclosed herein. It should be appreciated that in some embodiments, theother of the blocks may be different, certain blocks may be omitted,and/or blocks may be added.

The example procedure 3800 begins when the motor and lighting controller1520 and/or the processor 1562 receives an indication that a 5-ALAfluorescence mode of the stereoscopic visualization camera 300 has beenactivated by an operator (block 3802). The indication may include amessage or signal from, for example, the input device 1410 of FIGS. 14and 15. As described herein, the 5-ALA fluorescence mode includessuperimposing fluorescence graphics from a fluorescence scene onto avisible light scene during a visible light mode. To acquire one or morevideo frames or signals for the visible light scene, the motor andlighting controller 1520 and/or the processor 1562 causes the visiblelight source 708 a to be activated (block 3804) and causes the filterassembly 740 to rotate to the infrared cut filter or thenear-ultraviolet cut filter (block 3806). During this time, visiblelight is reflected from a surgical site 700 and received at the imagesensors 746 and 748, which convert the received light to image data(block 3808). The processor 1562 and/or a graphics processing unit 1564then combine the left and right image data into stereoscopic videosignals and/or video data for display on a monitor as the visible lightscene (block 3810). The motor and lighting controller 1520 and/or theprocessor 1562 continues to remain in the visible light mode for atleast the exposure time for one frame.

At a designated time, the motor and lighting controller 1520 and/or theprocessor 1562 acquires one or more video frames or signals for thefluorescence light scene by switching to a fluorescence mode. The motorand lighting controller 1520 and/or the processor 1562 switches fromvisible light mode to 5-ALA fluorescence mode by causing the NUV lightsource 708 c to be activated (block 3812) and causes the filter assembly740 to rotate to the 5-ALA emissions filter (e.g., the near-ultravioletcut filter) (block 3814). The switching of modes may be performed duringa blanking time of the image sensors 746 and 748. During thefluorescence mode, mixed excitation and emissions light is reflectedfrom a surgical site 700 and filtered to 5-ALA emission light, which isreceived at the image sensors 746 and 748 for conversion to image data(block 3816). The processor 1562 and/or the graphics processing unit1564 then combine the left and right image data into stereoscopic videosignals and/or video data as the fluorescence light scene (block 3818).The processor 1562 and/or the graphics processing unit 1564 mayvisualize the areas in the video image that correspond to fluorescencelight by applying at least one graphic or changing pixel colors to alight wavelength that is viewable to an operator. The motor and lightingcontroller 1520 and/or the processor 1562 continues to remain in thefluorescence light mode for at least the exposure time for one frame.

It should be appreciated that due to the peak emission wavelength of5-ALA being in the 635 nm range, the red pixels of the image sensors 746and 748 that are capturing the emitted photons have higher outputscompared to other pixels. The small change in values can be identifiedby the processor 1562 and/or the graphics processing unit 1564 via imageprocessing for accentuating the difference by overlying brighter colorsover the slightly hotter pixels. This enables the fluorescence emissionto be clearly visible to an operator, thereby providing for the imagingof any glioblastoma in the patient. This enables a surgeon to removemore of a patient's tumor than is otherwise possible to help increasethe life expectancy of the patient.

The processor 1562 and/or the graphics processing unit 1564 is alsoconfigured to combine the fluorescence video with the visible lightvideo. In some embodiments, this includes overlaying the fluorescencevideo frame on top of the visible light video frames (e.g., combiningthe separate visible and fluorescence images into a single image bylaying the fluorescence image over the visible image). In otherembodiments, the processor 1562 and/or the graphics processing unit 1564is configured to extract the portions of the fluorescence video frame(or the created fluorescence graphics) that comprise fluorescenceportions, identify corresponding locations in the visible light videoframes using, for example, shape or feature matching, and superimpose oroverlay the fluorescence portions on top of the corresponding visiblelight portions. The combined video is then provided for display showingareas of tissue with fluorescence superimposed on the visible video.This configuration provides a surgeon an improved view of thesurrounding tissue while also highlighting, for example, fluorescingtumors. After the video signals are displayed, the procedure returns toblock 3804 to acquire additional visible video frames. The exampleprocedure 3800 continues until the 5-ALA fluorescence mode is disabledor deactivated.

Similar to ICG fluorescence discussed above, the motor and lightingcontroller 1520 and/or the processor 1562 may acquire alternating framesin the visible light and fluorescence modes at virtually any ratio. Inaddition, the motor and lighting controller 1520 and/or the processor1562 are configured to provide an option for an operator to viewside-by-side fluorescence and visible light views. Further, theinfrared-cut filter or the near-ultraviolent cut filter may be selectedfor the right optical path to provide visible light to the right imagesensor 746 while the near-ultraviolent cut filter is selected for theleft optical path to provide 5-ALA excitation fluorescence light to theleft image sensor 748. In this configuration, the processor 1562 and/orthe graphics processing unit 1564 produces two two-dimensional displays,one display being the visible light view and the other being the 5-ALAfluorescence view.

CONCLUSION

It will be appreciated that each of the systems, structures, methods andprocedures described herein may be implemented using one or morecomputer programs or components. These programs and components may beprovided as a series of computer instructions on any conventionalcomputer-readable medium, including random access memory (“RAM”), readonly memory (“ROM”), flash memory, magnetic or optical disks, opticalmemory, or other storage media, and combinations and derivativesthereof. The instructions may be configured to be executed by aprocessor, which when executing the series of computer instructionsperforms or facilitates the performance of all or part of the disclosedmethods and procedures.

It should be understood that various changes and modifications to theexample embodiments described herein will be apparent to those skilledin the art. Such changes and modifications can be made without departingfrom the spirit and scope of the present subject matter and withoutdiminishing its intended advantages. It is therefore intended that suchchanges and modifications be covered by the appended claims. Moreover,consistent with current U.S. law, it should be appreciated that 35U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, paragraph 6 is not intended tobe invoked unless the terms “means” or “step” are explicitly recited inthe claims. Accordingly, the claims are not meant to be limited to thecorresponding structure, material, or actions described in thespecification or equivalents thereof.

The invention is claimed as follows:
 1. A stereoscopic imaging apparatuscomprising: a main objective assembly configured to change a workingdistance along an optical axis to a target surgical site; left and rightlens sets defining respective parallel left and right optical pathsalong the optical axis and configured to form the respective opticalpaths from light that is received from the main objective assembly ofthe target surgical site; a light filter assembly having left and rightfilter magazines positioned respectively along the left and rightoptical paths and configured to selectively enable certain wavelengthsof the light to pass through, each of the left and right filtermagazines including: an infrared cut filter, a near-ultraviolet cutfilter, and a near-infrared bandpass filter; left and right imagesensors configured to receive the filtered light and convert thefiltered light into image data that is indicative of the receivedfiltered light; a processor communicatively coupled to the left andright image sensors and configured to convert the image data intostereoscopic video signals or video data for display on a displaymonitor; a visible light source positioned to transmit visible light tothe target surgical site; a near-infrared light source positioned totransmit near-infrared light to the target surgical site; an excitationfilter positioned in front of the near-infrared light source andconfigured to enable light at indocyanine green (“ICG”) fluorescenceabsorption wavelengths to pass through; and a controller configured to:provide a visible light mode by causing the visible light reflected fromthe target surgical site to be provided to the left and right imagesensors by activating the visible light source and selecting at leastone of the infrared cut filter or the near-ultraviolet cut filter to beplaced in the respective optical path, provide an ICG fluorescence modeby causing ICG fluorescence emission light from the target surgical siteto be provided to the left and right image sensors by activating atleast one of the visible light source or the near-infrared light sourceand selecting the near-infrared bandpass filter to be placed in therespective optical path, and switch between the visible light mode andthe ICG mode to enable the processor to provide stereoscopic videosignals or video data with at least some image data corresponding to theICG fluorescence emission light to be superimposed on image datacorresponding to the visible light.
 2. The imaging apparatus of claim 1,wherein the left and right filter magazines each include six sides wherea first two parallel sides each include the infrared cut filter, asecond two parallel sides each include the near-ultraviolet cut filter,and a third two parallel sides each include the near-infrared bandpassfilter.
 3. The imaging apparatus of claim 1, wherein the left and rightfilter magazines each include six sides where a first side includes theinfrared cut filter, a second side includes the near-ultraviolet cutfilter, and a third side includes the near-infrared bandpass filter. 4.The imaging apparatus of claim 1, wherein the filter assembly includesan axle configured to connect to the left and right filter magazines andmechanically connect to a motor controlled by the controller forrotating each of the left and right filter magazines.
 5. The imagingapparatus of claim 1, wherein the excitation filter is configured toenable light between a wavelength of 710 nanometers (“nm”) and 822 nm topass through, corresponding to the ICG fluorescence absorptionwavelengths, and wherein the near-infrared bandpass filter is configuredto enable light between a wavelength of 817 nm and 900 nm to passthrough, corresponding to the ICG fluorescence emission light.
 6. Theimaging apparatus of claim 1, wherein the processor is configured to:identify the image data corresponding to the ICG fluorescence emissionlight based on pixel color values; and apply a pixel color that isvisible to an operator to the identified pixels for superimposing on theimage data corresponding to the visible light.
 7. The imaging apparatusof claim 1, wherein the controller is configured to switch between thevisible light mode and the ICG fluorescence mode during a blankingperiod of the left and right image sensors.
 8. The imaging apparatus ofclaim 1, wherein the controller is configured to select the visiblelight mode for at least one of one, two, three, four, or fiveconsecutive video frames for the stereoscopic video signals or the videodata corresponding to the visible light.
 9. The imaging apparatus ofclaim 8, wherein the controller is configured to select the ICGfluorescence mode for at least one of one, two, three, four, or fiveconsecutive video frames for the stereoscopic video signals or the videodata corresponding to the ICG fluorescence emission light.
 10. Theimaging apparatus of claim 9, wherein the processor is configured tosuperimpose one video frame, the stereoscopic video signals, or thevideo data corresponding to the ICG fluorescence emission light on morethan one frame, the stereoscopic video signals, or the video datacorresponding to the visible light.
 11. The imaging apparatus of claim1, further comprising a deflecting element that is located between themain objective assembly and the left and right lens sets, the deflectingelement configured to reflect the light received from the main objectiveassembly to the left and right lens sets, wherein the deflecting elementis coated or configured to reflect only light wavelengths that arebeyond the near-ultraviolet light wavelengths range to enable lighthaving near-ultraviolet light wavelengths from the near-ultravioletlight source to pass through the deflecting element to the mainobjective assembly.
 12. The imaging apparatus of claim 1, furthercomprising: a near-ultraviolet (“NUV”) light source positioned totransmit NUV light to the target surgical site; and a NUV excitationfilter positioned in front of the NUV light source and configured toenable light at a 5-aminolevulinic acid (“ALA”) fluorescence absorptionwavelengths to pass through, wherein the controller is configured to:provide a 5-ALA fluorescence mode by causing 5-ALA fluorescence emissionlight from the target surgical site to be provided to the left and rightimage sensors by activating the NUV light source and selecting thenear-ultraviolet cut filter to be placed in the respective optical path,and interchangeably switch between the visible light mode and the 5-ALAmode to enable the processor to provide stereoscopic video signals orvideo data with at least some image data corresponding to the 5-ALAfluorescence emission light to be superimposed on image datacorresponding to the visible light.